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Newberger NG, Ho D, Thomas ED, Goldstein SC, Coutu SM, Avila AL, Stein LAR, Weiss NH. Observations of substance use treatment engagement during the period of community re-entry following residential treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209430. [PMID: 38852820 DOI: 10.1016/j.josat.2024.209430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND The period of community re-entry following residential substance use treatment is associated with elevated risk for return to substance use. Although continuity of care is best practice, many individuals do not engage in follow-up treatment, struggle to engage in follow-up treatment, or continue to use substances while participating in follow-up treatment. There is a need to both characterize treatment engagement during community re-entry following residential substance use treatment as well as understand how treatment impacts substance use during this high-risk period. METHOD This observational study used retrospective self-report to examine treatment engagement and substance use among individuals who had exited residential substance use treatment. Participants completed a Timeline Follow-back interview reporting substance use and treatment engagement in the 30 days following residential treatment. RESULTS Most participants (83.1 %) reported engaging in substance use treatment following discharge. The most common treatments were Alcoholics Anonymous/Narcotics Anonymous (61.1 %), medication for addiction treatment (40 %), and outpatient therapy (29.2 %). Participants were less likely to use substances on a day in which they engaged in outpatient therapy (OR = 0.32, 95 % CI [0.12, 0.90], p = 0.030) and more likely on days they engaged in medication treatment (OR = 21.49, 95 % CI [1.46, 316.74], p = 0.025). CONCLUSION Findings characterize engagement in substance use treatment in the month following residential treatment. Treatment engagement was common during community re-entry; however, only outpatient therapy was found to reduce substance use during this high-risk period. Findings may inform intervention efforts during the high-risk period of community re-entry.
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Affiliation(s)
- Noam G Newberger
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Diana Ho
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Emmanuel D Thomas
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Stephen M Coutu
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Alyssa L Avila
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America
| | - Lynda A R Stein
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America; Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, Cranston, RI, United States of America
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, United States of America.
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Oliver K, Savic M. Putting tendencies and trajectories to work: useful tools for engaging with accounts of change and recovery? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 132:104563. [PMID: 39213828 DOI: 10.1016/j.drugpo.2024.104563] [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: 02/04/2024] [Revised: 07/23/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
Dominant understandings of recovery emphasise personal responsibility for initiating and sustaining changes in people's subjectivities and relationships to alcohol and other drugs. However, this potentially obscures the complexities and temporalities of change processes and the range of socio-material elements involved. Addressing this gap, critical drug studies scholars have productively employed the concepts of tendencies and trajectories to analyse how past events of drug consumption flow into current and future consumption events. Critiquing notions of personal responsibility within recovery processes, we apply the concepts of tendencies and trajectories to help explain recovery's emergence and continuities. Doing so helps decentre the individual as the agent responsible for improved capacity by broadening the perspective of developing health and wellbeing. In this paper, we provide a qualitative analysis of interviews with fourteen people with lived recovery experiences within an urban-rural setting in Melbourne, Australia. This analysis illustrates how recovery tendencies and trajectories are cultivated through repeated actions, habits, and practices over time. Applying the concept of trajectories to change narratives reveals how accumulated moments precede and follow turning points, supporting shifts in consumption patterns. These moments are not necessarily connected but, when considered collectively, contribute to a recovery trajectory and assemblage of health. In reflecting on the affordances of thinking, researching and doing with recovery tendencies and trajectories, we argue that analysing tendencies and trajectories illuminate opportunities where change lies within an endless combination of human and non-human forces. Applying these concepts to recovery research, practice, and policy engages with temporal and socio-material elements of recovery, offering a more emancipatory approach than is currently provided by common recovery theories and approaches that assume individuals are personally responsible for change.
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Affiliation(s)
- Katrin Oliver
- Hamilton Centre, Monash University, VIC and Eastern Health Clinical School, Eastern Health, Level 1, 110 Church St., Richmond, VIC 3121, Australia.
| | - Michael Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia.
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Winters DE, Massey SH, Sakai JT. Adolescent substance use outcomes in response to social consequences of use: the role of empathy. JOURNAL OF DRUG ISSUES 2024; 54:202-217. [PMID: 38434989 PMCID: PMC10906742 DOI: 10.1177/00220426231159303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Evidence suggests empathy deficits have a temporal relationship with substance use severity by late adolescence theorized to decrease use via recognition of social consequences. However, this has yet to be tested empirically along with differences in cognitive and affective empathy. Adolescents admitted to substance use treatment (n= 3,382) were followed through treatment and 12 months after treatment. Variable trajectories were fit using growth curve models; and cross-lagged effects of cognitive and affective empathy on response to social consequences of use were tested along with how response to social consequences affected the mean trajectory of substance use. Results indicate higher cognitive empathy predicted greater response to social consequences of use and response to these consequences at the end of treatment predicted a steeper decrease in substance use. This evidence highlights the importance of cognitive empathy for responding to social consequences of use for motivating less substance use in adolescents.
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Affiliation(s)
- Drew E Winters
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, 13001 e. 17th place, Aurora, CO 80045-2559, USA
| | - Suena H Massey
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Joseph T Sakai
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, 13001 e. 17th place, Aurora, CO 80045-2559, USA
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Bórquez I, Cerdá M, González-Santa Cruz A, Krawczyk N, Castillo-Carniglia Á. Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile. Addiction 2024; 119:753-765. [PMID: 38192124 DOI: 10.1111/add.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/16/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIMS Longitudinal studies have revealed that substance use treatment use is often recurrent among patients; the longitudinal patterns and characteristics of those treatment trajectories have received less attention, particularly in the global south. This study aimed to disentangle heterogeneity in treatment use among adult patients in Chile by identifying distinct treatment trajectory groups and factors associated with them. DESIGN National-level registry-based retrospective cohort. SETTING AND PARTICIPANTS Adults admitted to publicly funded substance use disorder treatment programs in Chile from November 2009 to November 2010 and followed for 9 years (n = 6266). MEASUREMENTS Monthly treatment use; type of treatment; ownership of the treatment center; discharge status; primary substance used; sociodemographic. FINDINGS A seven-class treatment trajectory solution was chosen using latent class growth analysis. We identified three trajectory groups that did not recur and had different treatment lengths: Early discontinuation (32%), Less than a year in treatment (19.7%) and Year-long episode, without recurrence (12.3%). We also identified a mixed trajectory group that had a long first treatment or two treatment episodes with a brief time between treatments: Long first treatment, or immediate recurrence (6.3%), and three recurrent treatment trajectory groups: Recurrent and decreasing (14.2%), Early discontinuation with recurrence (9.9%) and Recurrent after long between treatments period (5.7%). Inpatient or outpatient high intensity (vs. outpatient low intensity) at first entry increased the odds of being in the longer one-episode groups compared with the Early discontinuation group. Women had increased odds of belonging to all the recurrent groups. Using cocaine paste (vs. alcohol) as a primary substance decreased the odds of belonging to long one-episode groups. CONCLUSIONS In Chile, people in publicly funded treatment for substance use disorder show seven distinct care trajectories: three groups with different treatment lengths and no recurring episodes, a mixed group with a long first treatment or two treatment episodes with a short between-treatment-episodes period and three recurrent treatment groups.
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Affiliation(s)
- Ignacio Bórquez
- Center for Opioid Epidemiology and Policy (COEP), Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy (COEP), Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Andrés González-Santa Cruz
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
- Society and Health Research Center and School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile
- School of Public Health, Universidad de Chile, Santiago, Chile
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy (COEP), Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
| | - Álvaro Castillo-Carniglia
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
- Society and Health Research Center and School of Public Health, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Santiago, Chile
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Oster C, Hunter S, Schultz T, Harvey G, Lawless M, Battersby M. Barriers and facilitators to the implementation of the Flinders Chronic Condition Management Program in outpatient drug and alcohol settings in Australia. Drug Alcohol Rev 2024; 43:705-717. [PMID: 38098184 DOI: 10.1111/dar.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/20/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION There has been a growing call for drug and/or alcohol dependence to be managed as a chronic condition. The Flinders Chronic Condition Management Program (Flinders Program) was implemented in a drug and alcohol service in Australia in 2019-2022 to explore the feasibility of chronic condition management in outpatient clinics. Implementation involved: adaptation of the Flinders Program; adaptation of clinical procedures; training clinicians and managers; training Flinders Program Accredited Trainers; and system integration. This study aims to explore barriers and enablers to implementation. METHODS A qualitative formative evaluation was undertaken. Data included implementation documents (n = 7), responses to open-ended questions in post-training surveys (n = 27), and focus groups and interviews with implementation staff, clinicians, managers and a trainer (n = 16). Data were analysed using the Consolidated Framework for Implementation Research in a 'coding reliability' approach to thematic analysis. RESULTS Participants responded positively to the Flinders Program's philosophy, processes, tools and training. However, barriers were identified across three Consolidated Framework for Implementation Research domains: (i) outer setting (client suitability and incompatibility with external policies and incentives); (ii) characteristics of individuals (low self-efficacy); and (iii) inner setting (lack of system and workflow integration). DISCUSSION AND CONCLUSIONS Executive support and systems integration are important for the implementation of the Flinders Program in drug and alcohol services. This needs to be achieved within externally mandated key performance indicators for outpatient services. Further research is needed to fully evaluate the potential of a chronic condition management framework in Australian outpatient drug and alcohol services.
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Affiliation(s)
- Candice Oster
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Timothy Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Gillian Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Moe FD, Erga A, Bjornestad J, Dettweiler U. The interdependence of substance use, satisfaction with life, and psychological distress: a dynamic structural equation model analysis. Front Psychiatry 2024; 15:1288551. [PMID: 38404472 PMCID: PMC10884273 DOI: 10.3389/fpsyt.2024.1288551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Longitudinal studies with annual follow-up including psychological and social variables in substance use disorder recovery are scarce. We investigated whether levels of substance use, satisfaction with life, and psychological distress fluctuate across five years in relation to having drug-free friends. Methods A prospective naturalistic cohort study of change trajectories in a cohort of people diagnosed with substance use disorder and using multiple substances with quarterly and annual follow-up over five years. Two-hundred-and-eight patients were recruited from substance use disorder treatment in Rogaland, Norway. Out of these, 164 participants fulfilled the inclusion criteria. We used Bayesian two-level dynamic structural equation modelling. The variable 'drug-free friends' was assessed by a self-reporting questionnaire, while psychological distress was assessed using the Symptoms Checklist 90 Revised. Satisfaction with life was assessed using the Satisfaction With Life Scale while drug use was assessed using the Drug Use Disorders Identification Test. Results The main findings are that higher-than-average psychological distress at a three-month lag credibly predicts higher-than-normal substance use at the concurrent time point t. Substance use and satisfaction with life seem to have synchronous trajectories over time, i.e. as the first decreases the latter increases and vice versa. During the five years after treatment, the participants mainly experienced a decrease in substance use and increase in satisfaction with life. Conclusion Since the participants experienced positive and negative fluctuations for several years after treatment, it seems crucial to establish a dialogue with treatment professionals in order to create functional solutions for maintaining motivation and aiding recovery.
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Affiliation(s)
- Fredrik D. Moe
- Department of Mental Health, Haukeland University Hospital, Bergen, Norway
- Centre for the Study of the Sciences and the Humanities, University of Bergen, Bergen, Norway
| | - Aleksander Erga
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- TIPS – Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Ulrich Dettweiler
- Cognitive and Behavioural Neuroscience Lab, University of Stavanger, Stavanger, Norway
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Obuobi-Donkor G, Shalaby R, Agyapong B, Dias RDL, Agyapong VIO. Mitigating Psychological Problems Associated with the 2023 Wildfires in Alberta and Nova Scotia: Six-Week Outcomes from the Text4Hope Program. J Clin Med 2024; 13:865. [PMID: 38337558 PMCID: PMC10856019 DOI: 10.3390/jcm13030865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Background: In 2023, wildfires led to widespread destruction of property and displacement of residents in Alberta and Nova Scotia, Canada. Previous research suggests that wildfires increase the psychological burden of impacted communities, necessitating population-level interventions. Cognitive Behavioural Therapy (CBT)-based text message interventions, Text4HopeAB and Text4HopeNS, were launched in Alberta and Nova Scotia, respectively, during the 2023 wildfire season to support the mental health of impacted individuals. Objectives: The study examines the effectiveness of Text4HopeNS and Text4HopeAB in alleviating psychological symptoms and improving wellbeing among subscribers. Methods: The study involved longitudinal and naturalistic controlled trial designs. The longitudinal study comprised subscribers who completed program surveys at baseline and six weeks post-enrolment, while the naturalistic controlled study compared psychological symptoms in subscribers who had received daily supportive text messages for six weeks (intervention group) and new subscribers who had enrolled in the program during the same period but had not yet received any text messages (control group). The severity of low resilience, poor mental wellbeing, likely Major Depressive Disorder (MDD), likely Generalized Anxiety Disorder (GAD), likely Post-Traumatic Stress Disorder (PTSD), and suicidal ideation were measured on the Brief Resilience Scale (BRS), the World Health Organization-5 Wellbeing Index (WHO-5), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) scale, PTSD Checklist-Civilian Version (PCL-C), and the ninth question on the PHQ-9, respectively. The paired and independent sample t-tests were employed in data analysis. Results: The results from the longitudinal study indicated a significant reduction in the mean scores on the PHQ-9 (-12.3%), GAD-7 (-14.8%), and the PCL-C (-5.8%), and an increase in the mean score on the WHO-5, but not on the BRS, from baseline to six weeks. In the naturalistic controlled study, the intervention group had a significantly lower mean score on the PHQ-9 (-30.1%), GAD-7 (-29.4%), PCL-C (-17.5%), and the ninth question on the PHQ-9 (-60.0%) which measures the intensity of suicidal ideation, and an increase in the mean score on the WHO-5 (+24.7%), but not on the BRS, from baseline to six weeks compared to the control group. Conclusions: The results of this study suggests that the Text4Hope program is an effective intervention for mitigating psychological symptoms in subscribers during wildfires. This CBT-based text messaging program can be adapted to provide effective support for individuals' mental health, especially in the context of traumatic events and adverse experiences such as those induced by climate change. Policymakers and mental health professionals should consider these findings when shaping strategies for future disaster response efforts, emphasizing the value of scalable and culturally sensitive mental health interventions.
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Affiliation(s)
- Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.O.-D.); (R.d.L.D.)
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (B.A.)
| | - Belinda Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (B.A.)
| | - Raquel da Luz Dias
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.O.-D.); (R.d.L.D.)
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (G.O.-D.); (R.d.L.D.)
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; (R.S.); (B.A.)
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Gao T, Luo JL, Guo P, Hu XW, Wei XY, Hu Y. Impact of continuous care on cardiac function in patients with lung cancer complicated by coronary heart disease. World J Clin Cases 2024; 12:314-321. [PMID: 38313633 PMCID: PMC10835687 DOI: 10.12998/wjcc.v12.i2.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/06/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Despite sharing similar pathogenic factors, cancer and coronary heart disease (CHD) occur in comparable populations at similar ages and possess similar susceptibility factors. Consequently, it is increasingly commonplace for patients to experience the simultaneous occurrence of cancer and CHD, a trend that is steadily rising. AIM To determine the impacts of continuing care on lung cancer patients with CHD following percutaneous coronary intervention (PCI). METHODS There were 94 lung cancer patients with CHD following PCI who were randomly assigned to the intervention group (n = 38) and the control group (n = 41). In the intervention group, continuing care was provided, while in the control group, routine care was provided. An evaluation of cardiac and pulmonary function, medication compliance, a 6-min walk test, and patient quality of life was performed. RESULTS Differences between the two groups were significant in left ventricular ejection fraction, 6-min walk test, oxygen uptake, quality of life and medication compliance (P < 0.05). In comparison with the control group, the enhancement in the intervention group was more significant. The intervention group had more patients with high medication compliance than the control group, with a statistically significant difference (P < 0.05). CONCLUSION After undergoing PCI, lung patients with CHD could benefit from continued care in terms of cardiac and pulmonary function, medications compliance, and quality of life.
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Affiliation(s)
- Ting Gao
- Division of Cardiovascular First Ward, Department of Internal Medicine, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei Province, China
| | - Jin-Lan Luo
- Department of Cardiovascular Medicine, Wuhan Wuchang Hospital, Wuhan 430063, Hubei Province, China
| | - Pan Guo
- Cardiovascular Clinical Medical Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei Province, China
| | - Xi-Wen Hu
- Cardiovascular Clinical Medical Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei Province, China
| | - Xiao-Yan Wei
- Cardiovascular Clinical Medical Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei Province, China
| | - Yan Hu
- Department of Second Thoracic Surgery, Hubei Cancer Hospital, Wuhan 430079, Hubei Province, China
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Dela Cruz AM, Karns-Wright T, Kahalnik F, Walker R, Lanham HJ, Potter JS, Trivedi MH. Stigma towards opioid use disorder in primary care remain a barrier to integrating software-based measurement based care. BMC Psychiatry 2023; 23:776. [PMID: 37875835 PMCID: PMC10598938 DOI: 10.1186/s12888-023-05267-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) is a deadly illness that remains undertreated, despite effective pharmacological treatments. Barriers, such as stigma, treatment affordability, and a lack of training and prescribing within medical practices result in low access to treatment. Software-delivered measurement-based care (MBC) is one way to increase treatment access. MBC uses systematic patient symptom assessments to inform an algorithm to support clinicians at critical decision points. METHOD Focus groups of faculty clinicians (N = 33) from 3 clinics were conducted to understand perceptions of OUD diagnosis and treatment and whether a computerized MBC model might assist with diagnosis and treatment. Themes from the transcribed focus groups were identified in two phases: (1) content analysis focused on uncovering general themes; and (2) systematic coding and interpretation of the data. RESULTS Analysis revealed six major themes utilized to develop the coding terms: "distinguishing between chronic pain and OUD," "current practices with patients using prescribed or illicit opioids or other drugs," "attitudes and mindsets about providing screening or treatment for OUD in your practice," "perceived resources needed for treating OUD," "primary care physician role in patient care not specific to OUD," and "reactions to implementation of proposed clinical decision support tool." CONCLUSION Results revealed that systemic and attitudinal barriers to screening, diagnosing, and treating OUD continue to persist. Providers tended to view the software-based MBC program favorably, indicating that it may be a solution to increasing accessibility to OUD treatment; however, further interventions to combat stigma would likely be needed prior to implementation of these programs. TRIAL REGISTRATION ClinicalTrials.gov; NCT04059016; 16 August 2019; retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT04059016 .
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Affiliation(s)
- Adriane M Dela Cruz
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Tara Karns-Wright
- Department of Psychiatry & Behavioral Sciences, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Farra Kahalnik
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Robrina Walker
- The Emmes Company, 401 N Washington St, Rockville, MD, 20850, USA
| | - Holly J Lanham
- Department of Psychiatry & Behavioral Sciences, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Jennifer Sharpe Potter
- Department of Psychiatry & Behavioral Sciences, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Hurlocker MC, Moyers TB, Hatch M, Curran G, McCrady B, Venner KL, Witkiewitz K. Effectiveness and feasibility of a motivational interviewing intake (MII) intervention for increasing client engagement in outpatient addiction treatment: an effectiveness-implementation hybrid design protocol. Addict Sci Clin Pract 2023; 18:63. [PMID: 37865777 PMCID: PMC10589931 DOI: 10.1186/s13722-023-00412-y] [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: 02/14/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Client discontinuation from outpatient addiction treatment programs is common, and the initial intake is the service delivery point with the highest attrition rate. Replacing the comprehensive intake assessment with a person-centered Motivational Interviewing (MI) intervention is a potential solution to address provider and client concerns about the disengaging, time-intensive nature of the typical initial intake. It remains unclear whether the use of an alternative to the standard intake at the initial visit can fit within typical organizational reporting requirements, whether it decreases attrition, and whether implementation of person-centered intake procedures within outpatient addiction treatment programs is feasible, acceptable, and can be sustained. PURPOSE To describe the methods and design of an effectiveness-implementation hybrid type 1 trial of a Motivational Interviewing at Intake (MII) intervention using the Consolidated Framework for Implementation Research (CFIR). METHODS The study will determine the effectiveness of two intake conditions: (1) standard comprehensive intake assessment (intake-as-usual [IAU]), and (2) MII consisting of a person-centered discussion between provider and client about the client's desire and intent to enter treatment. Although both interventions are focused on understanding client presenting complaints and needs for treatment, the delivery differs as the IAU uses a semi-structured assessment guide, while MII applies the theory of MI to have a conversation about treatment engagement. Adults seeking outpatient addiction treatment services will be randomly assigned to the MII condition (n = 75) or the IAU condition (n = 75). Primary outcomes will be client engagement (i.e., treatment entry, attendance, and completion) obtained from the electronic medical record. Secondary outcomes (client motivation and therapeutic alliance) will be putative mechanisms of client engagement assessed immediately before and after the intake. The trial also will explore determinants of effective, sustainable implementation using assessments of organizational readiness and capacity to change, as well as interviews on MII implementation feasibility. CONCLUSION This trial of an MII intervention will investigate the feasibility of a motivational intervention as an initial contact with substance use treatment-seeking clients as well as indicators of intervention effectiveness within the systems where it is employed. Trial registration Clinicaltrials.gov identifier: NCT05489068.
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Affiliation(s)
- Margo C Hurlocker
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA.
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, 87106, USA.
| | - Theresa B Moyers
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Melissa Hatch
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Geoffrey Curran
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
- Health Services Research and Development Service, Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72114, USA
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Barbara McCrady
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Kamilla L Venner
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, 87106, USA
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11
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Scott CK, Dennis ML, Grella CE, Watson DP, Davis JP, Hart MK. A randomized controlled trial of recovery management checkups for primary care patients: Twelve-month results. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1964-1977. [PMID: 37864532 PMCID: PMC10605959 DOI: 10.1111/acer.15172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/05/2023] [Accepted: 08/06/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Primary care settings like federally qualified health centers (FQHC) are optimal locations to identify individuals with substance use disorders (SUD) and link them to SUD treatment, yet successful linkage has proven difficult. Recovery management checkups for primary care (RMC-PC) is a promising method for increasing linkage to care, engagement in treatment, and reducing substance use. METHODS Participants (n = 266) who received screening, brief intervention, and referral to treatment (SBIRT) at four FQHC sites and needed SUD treatment were randomized to receive SBIRT only or SBIRT+RMC-PC. All participants received SBIRT prior to randomization as part of usual care while those in the experimental group also received quarterly checkups. All participants completed research interviews at enrollment and 3, 6, 9, and 12 months post-enrollment. The primary outcome was whether participants received any days of SUD treatment. Key secondary outcomes were days of SUD treatment (total and by SUD level of care), days of alcohol or drug abstinence, and a reduction in days of specific substance use, all based on self-report. RESULTS Relative to participants receiving SBIRT only, participants assigned to SBIRT+RMC-PC were significantly more likely to have received any SUD treatment over 12 months (adjusted odds ratio [AOR] = 3.85) and more days of SUD treatment over 12 months (Cohen's effect size d = +0.41). The SBIRT+RMC-PC group also reported significantly more days of abstinence over 12 months (d = +0.30), fewer days of alcohol use (d = -0.20) and cannabis use (d = -0.20), and lower combined substance use frequency (d = -0.25). Days of treatment were found to positively mediate the direct effect of SBIRT+RMC-PC on days of abstinence. CONCLUSION This study provides further evidence of the effectiveness of the "referral to treatment" component of SBIRT when combined with RMC for patients in primary care settings, including those with drug use problems. Moreover, results demonstrate the value of repeated checkups on longer-term treatment and substance use outcomes.
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Affiliation(s)
| | | | | | | | - Jordan P Davis
- Suzanne Dworak-Peck, School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - M Kate Hart
- Chestnut Health Systems, Normal, Illinois, USA
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12
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Houston AR, Snyder-Young D, Perry M, Flessen M, Lincoln AK. 'Let Others Love You Back to Health': The Role of Performance-based Support Groups for People in Recovery. Community Ment Health J 2023; 59:1097-1108. [PMID: 36692703 DOI: 10.1007/s10597-023-01089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023]
Abstract
Peer support groups have become widely utilized among those in recovery from problematic substance use. Yet, these peer-based programs vary and research examining their effectiveness has yielded mixed results. Relatively less is known about the impacts of arts-based peer recovery programs. Some research suggests that theatre may offer a powerful tool to address biopsychosocial changes among individuals in recovery. To explore the role of arts-based peer support programs, we draw on qualitative interviews with performers in two arts-based recovery programs. Our findings suggest that arts-based peer recovery programs may aid individuals in recovery in four main ways. Performing allowed participants to build relationships with others in recovery, channel experiences creatively while challenging stigma, foster confidence and recovery-identity formation, aiding participants in working through emotional impacts of prior substance use. These findings support emerging scholarship examining the role of performance in challenging stereotypes about substance use to aid those in recovery.
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Affiliation(s)
- Ashley R Houston
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA.
| | - Dani Snyder-Young
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA
- College of Arts, Media and Design, Northeastern University, Boston, USA
| | | | - Maren Flessen
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA
- College of Arts, Media and Design, Northeastern University, Boston, USA
| | - Alisa K Lincoln
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, USA
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13
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Hayes BB. Annual use and perceived need for mental health and substance treatment among people in remission from substance use disorders in the United States. Drug Alcohol Depend 2023; 249:110820. [PMID: 37329728 DOI: 10.1016/j.drugalcdep.2023.110820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Receiving specialty substance treatment or general mental health treatment during remission from substance use disorders (SUD) may reduce odds of SUD recurrence, but little is known about prevalence of treatment or perceptions of treatment need among remitted people in the United States. SAMPLE Participants in the National Survey on Drug Use and Health, years 2018-2020, were considered remitted if they ever had an SUD (i.e., self-reported history of "problems with alcohol or drugs", or lifetime history of treatment for SUD) but did not meet DSM-IV criteria for substance abuse or dependence during the prior year (n = 9,295). ANALYSES Annual prevalence was estimated for any SUD treatment (e.g., mutual-help groups), any mental health (MH) treatment (e.g., private therapy), self-reported perceived need for SUD treatment, and self-reported unmet need for MH treatment. Generalized linear models examined effects of socio-demographics, mental illness, past-year substance use, and self-identified recovery status on outcomes. FINDINGS MH treatment was more common than SUD treatment (27.2% [25.6%, 28.8%] v. 7.8% [7.0%, 8.6%], respectively). Unmet need for mental health treatment was reported by 9.8% [8.8%, 10.9%], but only 0.9% [0.6%, 1.2%] perceived need for substance treatment. Age, sex, marital status, education, health insurance, mental illness, and prior year alcohol use were among the factors associated with variation in outcomes. CONCLUSION Most people who maintained clinical remission from substance use disorders in the U.S. during the prior year did so without treatment. Remitted people report substantial unmet need for mental health treatment, but not specialized substance use treatment.
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Affiliation(s)
- Bridget B Hayes
- Department of Psychology, Cornell University, United States; Substance Abuse and Mental Health Services Administration, United States.
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14
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Guliyev C, Simsek M, Bezek-Dino S, Ogel K. Life Chart of Substance Use Career: A Clinical Profile Study from Turkey. PSYCHIAT CLIN PSYCH 2023; 33:117-125. [PMID: 38765925 PMCID: PMC11082583 DOI: 10.5152/pcp.2023.23617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/22/2023] [Indexed: 05/22/2024] Open
Abstract
Background The "career approach," developed to understand substance use and treatment, is important because it can broadly encompass the complexity of addiction patterns and help to better illustrate the chronic and recurrent nature, correlations, and consequences of addiction. The current study aimed to examine the substance use career and patterns of patients diagnosed with substance use disorder. Methods The authors created a questionnaire that included questions inquiring at what age several substance use-related life events occurred. The Addiction Profile Index was used to collect sociodemographic data and measure substance use disorder severity. Descriptive statistics and group comparisons were conducted to evaluate the data. Results Of the cases (n = 400), 72.7% began using substances before the age of 18, but only 12.4% (n = 68) sought treatment by that age. There were approximately 8 years between starting substance use and seeking treatment. Substance use was noticed by the family approximately 5 years after it started. There was a difference between males and females in terms of the age of experiencing adverse life events due to substance use, with females being earlier (P = .030). Similarly, individuals with opioid use disorder experienced adverse life events due to substance use at an earlier age than the non-opioid group (P = .001). Conclusion Identifying patient characteristics associated with the course of use in people who use different substances of choice and examining the differences in lifelong substance use patterns among these groups will help develop targeted treatment services and policies.
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Affiliation(s)
- Cavid Guliyev
- Department of Psychology, Istanbul Kent University, Istanbul, Turkey
- Alcohol and Substance Addiction Treatment Center, Moodist Psychiatry Hospital, Istanbul Turkey
| | - Melike Simsek
- The Turkish Green Crescent Counseling Center, Istanbul, Turkey
| | - Sevinc Bezek-Dino
- Alcohol and Substance Addiction Treatment Center, Moodist Psychiatry Hospital, Istanbul Turkey
| | - Kultegin Ogel
- Department of Psychology, Istanbul Kent University, Istanbul, Turkey
- Alcohol and Substance Addiction Treatment Center, Moodist Psychiatry Hospital, Istanbul Turkey
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15
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Hazama K, Katsuta S. Factors to Reduce Drug-Related Recidivism Among Paroled Methamphetamine Users in Japan: 10-Year Data Analysis. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023:306624X231172651. [PMID: 37178158 DOI: 10.1177/0306624x231172651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This study explored factors to reduce drug-related recidivism among paroled methamphetamine users in Japan, especially the significance of continuing care and motivation, internationally shown as positively related to better treatment outcomes. Cox proportional hazards regression analysis was performed on 10-year drug-related recidivism data from 4,084 methamphetamine users paroled in 2007 who received a mandatory educational program conducted by professional and volunteer probation officers. Independent variables included participant characteristics, an index of motivation, and the length of parole as a substitute for the duration of continuing care with consideration of the Japanese legal system structures and socio-cultural context. Older age, lower number of previous prison sentences, shorter imprisonment, longer parole, and index of higher motivation were significantly and negatively associated with drug-related recidivism. The results indicate the benefit of continuing care and motivation on treatment outcomes, regardless of the differences in socio-cultural context and criminal justice system.
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Affiliation(s)
| | - Satoshi Katsuta
- Yokohama Probation Office, Ministry of Justice in Japan, Kanagawa, Japan
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16
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Ramadas E, de Lima MP, Caetano T, Lopes J, Dixe MDACR. Effectiveness of smartphone interventions as continuing care for substance use disorders: A systematic review. Acta Psychol (Amst) 2023; 235:103898. [PMID: 37001396 DOI: 10.1016/j.actpsy.2023.103898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 02/27/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
As a chronic disease with consistent relapse rates, substance use disorders (SUD) require a continuity-of-care approach. Unfortunately, many patients do not have access to continuing care. This systematic review analysed the current scientific knowledge to better understand if app-based smartphone interventions can be an effective alternative. The databases Cochrane Library, PubMed, Web of Science, and PsycINFO were used to find experimental and quasi-experimental studies investigating the effectiveness of a smartphone intervention in individuals who had completed treatment for SUD. After removing duplicates, a total of 1488 studies were screened, with 48 being selected for a full-text review. Four studies met all the criteria, with one other being added by identification through other resources, making a total of 5 studies included in the present review. Out of the four studies using a control group, only one found no significant differences in favour of the experimental group. That study used an active control group and compared the smartphone intervention to its therapeutic group equivalent. There were no significant differences between the two experimental groups. Overall, the results indicate that app-based smartphone interventions can be an effective alternative to traditional forms of continuing care. However, literature is still scarce, and more research needs to be made on this subject. This systematic review is registered at PROSPERO with the identifier [CRD42021272070].
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17
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Obuobi-Donkor G, Shalaby R, Vuong W, Agyapong B, Hrabok M, Gusnowski A, Surood S, Greenshaw AJ, Agyapong VI. Effects of Text4Hope-Addiction Support Program on Cravings and Mental Health Symptoms: Results of a Longitudinal Cross-sectional Study. JMIR Form Res 2023; 7:e40440. [PMID: 36857114 PMCID: PMC10018381 DOI: 10.2196/40440] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/23/2022] [Accepted: 11/11/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Drug misuse is complex, and various treatment modalities are emerging. Providing supportive text messages to individuals with substance use disorder offers the prospect of managing and improving symptoms of drug misuse and associated comorbidities. OBJECTIVE This study evaluated the impact of the daily supportive text message program (Text4Hope-Addiction Support) in mitigating cravings and mental health symptoms in subscribers and quantify user satisfaction with the Text4Hope-Addiction Support program. METHODS Subscribers to the Text4Hope-Addiction Support program received daily supportive text messages for 3 months; the messages were crafted based on addiction counseling and cognitive behavioral therapy principles. Participants completed an anonymous web-based questionnaire to assess cravings, anxiety, and depressive symptoms using the Brief Substance Craving Scale (BSCS), Generalized Anxiety Disorder-7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale at enrollment (baseline), after 6 weeks, and after 3 months. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope-Addiction program. RESULTS In total, 408 people subscribed to the program, and 110 of 408 (26.9%) subscribers completed the surveys at least at one time point. There were significant differences between the mean baseline and 3-month BSCS scores P=.01 (-2.17, 95% CI -0.62 to 3.72), PHQ-9 scores, P=.004 (-5.08, 95% CI -1.65 to -8.51), and GAD-7 scores, P=.02 (-3.02, 95% CI -0.48 to -5.56). Participants who received the supportive text messages reported a reduced desire to use drugs and a longer time interval between substance use, which are reflected in 41.1% and 32.5% decrease, respectively, from baseline score. Approximately 89% (23/26) of the participants agreed that Text4Hope-Addiction program helped them cope with addiction-related stress, and 81% (21/25) of the participants reported that the messages assisted them in dealing with anxiety. Overall, 69% (18/26) of the participants agreed that it helped them cope with depression related to addiction; 85% (22/26) of the participants felt connected to a support system; 77% (20/26) of the participants were hopeful of their ability to manage addiction issues; and 73% (19/26) of the participants felt that their overall mental well-being was improved. Most of the participants agreed that the interventions were always positive and affirmative (19/26, 73%), and succinct (17/26, 65%). Furthermore, 88% (21/24) of the participants always read the messages; 83% (20/24) of the participants took positive or beneficial actions after reading; and no participant took a negative action after reading the messages. In addition, most participants agreed to recommend other diverse technology-based services as an adjunctive treatment for their mental and physical health disorders. CONCLUSIONS Subscribers of Text4Hope-Addiction Support program experienced improved mental health and addiction symptoms. Addiction care practitioners and policy makers can implement supportive text-based strategies to complement conventional treatments for addiction, given that mobile devices are widely used.
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Affiliation(s)
- Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Marianne Hrabok
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Vincent Io Agyapong
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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18
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Francia L, Lam T, Berg A, Morgan K, Savic M, Lubman DI, Nielsen S. Putting out the welcome mat-A qualitative exploration of service delivery processes and procedures as barriers to treatment-seeking for people who use alcohol and other drugs. Drug Alcohol Rev 2023; 42:193-202. [PMID: 36169553 PMCID: PMC10947049 DOI: 10.1111/dar.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long-established, less is known about how specific aspects of service delivery impact treatment-seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery. METHODS Thirty-nine semi-structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health-care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment-seeking. RESULTS Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment-seeking and engagement. Within broader health-care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment-seeking. DISCUSSION AND CONCLUSIONS Results suggest opportunities to engage and undertake needs-based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health-care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care.
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Affiliation(s)
- Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Amelia Berg
- Association of Participating Services UsersSelf Help Addiction Resource CentreMelbourneAustralia
| | | | - Michael Savic
- Turning PointEastern Health Clinical SchoolMelbourneAustralia
- Monash UniversityMelbourneAustralia
| | - Dan I. Lubman
- Turning PointEastern Health Clinical SchoolMelbourneAustralia
- Monash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
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Frone MR, Casey Chosewood L, Osborne JC, Howard JJ. Workplace Supported Recovery from Substance Use Disorders: Defining the Construct, Developing a Model, and Proposing an Agenda for Future Research. OCCUPATIONAL HEALTH SCIENCE 2022; 6:475-511. [PMID: 37206918 PMCID: PMC10193449 DOI: 10.1007/s41542-022-00123-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 05/21/2023]
Abstract
Substance use disorders (SUDs) represent a critical public and occupational health issue. Therefore, understanding the process of SUD recovery has become an issue of growing importance among substance use and recovery professionals. Nonetheless, despite the acknowledged importance of employment for SUD recovery, little conceptual or empirical work exists on how the workplace might support or undermine SUD recovery. In this article, we address this limitation in several ways. First, to promote a better understanding of SUD recovery for occupational health researchers, we provide a brief overview of the nature of a SUD, prior definitions of SUD recovery, and general themes associated with the recovery process. Second, we develop a working definition of workplace supported recovery. Third, we present a heuristic conceptual model showing how the workplace might impact the SUD recovery process. Fourth, using this model and research from the substance use and occupational health literatures, we develop a series of general research propositions. These propositions highlight broad directions requiring more detailed conceptualization and empirical research to understand better how work conditions may support or undermine the process of employee SUD recovery. Our overarching goal is to motivate innovative conceptualization and research on workplace supported recovery from SUDs. Such research may inform the development and evaluation of workplace interventions and policies supporting SUD recovery and highlight the benefits of workplace supported SUD recovery for employees, employers, and communities. Research on this issue may allow occupational health researchers to impact a significant societal and occupational health issue.
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Affiliation(s)
- Michael R. Frone
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - L. Casey Chosewood
- Office of the Director, Office for Total Worker Health®, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Atlanta, GA, United States
| | - Jamie C. Osborne
- Office of the Director, Office for Policy, Planning and Evaluation, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Atlanta, GA, United States
| | - John J. Howard
- Office of the Director, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Washington, DC, United States
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20
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Telehealth interventions for substance use disorders in low- and- middle income countries: A scoping review. PLOS DIGITAL HEALTH 2022; 1:e0000125. [PMID: 36812539 PMCID: PMC9931245 DOI: 10.1371/journal.pdig.0000125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/09/2022] [Indexed: 02/24/2023]
Abstract
The increasing prevalence and magnitude of harmful effects of substance use disorders (SUDs) in low- and middle-income countries (LMICs) make it imperative to embrace interventions which are acceptable, feasible, and effective in reducing this burden. Globally, the use of telehealth interventions is increasingly being explored as possible effective approaches in the management of SUDs. Using a scoping review of literature, this article summarizes and evaluates evidence for the acceptability, feasibility, and effectiveness of telehealth interventions for SUDs in LMICs. Searches were conducted in five bibliographic databases: PubMed, Psych INFO, Web of Science, Cumulative Index of Nursing and Allied Professionals and the Cochrane database of systematic review. Studies from LMICs which described a telehealth modality, identified at least one psychoactive substance use among participants, and methods that either compared outcomes using pre- and post-intervention data, treatment versus comparison groups, post-intervention data, behavioral or health outcome, and outcome of either acceptability, feasibility, and/or effectiveness were included. Data is presented in a narrative summary using charts, graphs, and tables. The search produced 39 articles across 14 countries which fulfilled our eligibility criteria over a period of 10 years (2010 to 2020). Research on this topic increased remarkably in the latter five years with the highest number of studies in 2019. The identified studies were heterogeneous in their methods and various telecommunication modalities were used to evaluate substance use disorder, with cigarette smoking as the most assessed. Most studies used quantitative methods. The highest number of included studies were from China and Brazil, and only two studies from Africa assessed telehealth interventions for SUDs. There has been an increasingly significant body of literature which evaluates telehealth interventions for SUDs in LMICs. Overall, telehealth interventions showed promising acceptability, feasibility, and effectiveness for SUDs. This article identifies gaps and strengths and suggests directions for future research.
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21
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Oesterle TS, Karpyak VM, Coombes BJ, Athreya AP, Breitinger SA, Correa da Costa S, Dana Gerberi DJ. Systematic review: Wearable remote monitoring to detect nonalcohol/nonnicotine-related substance use disorder symptoms. Am J Addict 2022; 31:535-545. [PMID: 36062888 DOI: 10.1111/ajad.13341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Substance use disorders (SUDs) are chronic relapsing diseases characterized by significant morbidity and mortality. Phenomenologically, patients with SUDs present with a repeating cycle of intoxication, withdrawal, and craving, significantly impacting their diagnosis and treatment. There is a need for better identification and monitoring of these disease states. Remote monitoring chronic illness with wearable devices offers a passive, unobtrusive, constant physiological data assessment. We evaluate the current evidence base for remote monitoring of nonalcohol, nonnicotine SUDs. METHODS We performed a systematic, comprehensive literature review and screened 1942 papers. RESULTS We found 15 studies that focused mainly on the intoxication stage of SUD. These studies used wearable sensors measuring several physiological parameters (ECG, HR, O2 , Accelerometer, EDA, temperature) and implemented study-specific algorithms to evaluate the data. DISCUSSION AND CONCLUSIONS Studies were extracted, organized, and analyzed based on the three SUD disease states. The sample sizes were relatively small, focused primarily on the intoxication stage, had low monitoring compliance, and required significant computational power preventing "real-time" results. Cardiovascular data was the most consistently valuable data in the predictive algorithms. This review demonstrates that there is currently insufficient evidence to support remote monitoring of SUDs through wearable devices. SCIENTIFIC SIGNIFICANCE This is the first systematic review to show the available data on wearable remote monitoring of SUD symptoms in each stage of the disease cycle. This clinically relevant approach demonstrates what we know and do not know about the remote monitoring of SUDs within disease states.
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Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M Karpyak
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon J Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Arjun P Athreya
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott A Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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22
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Moe FD, Berg H. Treating equivalent cases differently: A comparative analysis of substance use disorder and type 2 diabetes in Norwegian treatment guidelines. J Eval Clin Pract 2022; 28:721-728. [PMID: 35484825 PMCID: PMC9790317 DOI: 10.1111/jep.13693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Substance use disorder (SUD) is often understood as a chronic illness. AIMS This paper investigates whether SUD is treated as a chronic illness. METHOD To this aim, we have used World Health Organizations (WHO's) definition of chronic illness to conduct a comparative analysis of SUD and type 2 diabetes (T2D), which is another chronic illness. RESULTS When analysing Norwegian treatment guidelines, we found that only the T2D guideline reflects the WHO's conceptualization of chronic illnesses. We argue that this discrepancy implies that SUD is understood as a moral and legal problem, while T2D is conceptualized as a somatic illness. We discuss how social, political and historical conditions of the possibility for understanding SUD are interwoven with normative presumptions about the clinician, patient, treatment guidelines and drug policies in a way that may impede the development of continuing care. CONCLUSION The paper concludes that the delivery of treatment services is inequitable as SUD is not treated as a chronic illness.
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Affiliation(s)
- Fredrik D Moe
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.,Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Henrik Berg
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.,Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway.,Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Schwartz EKC, Wolkowicz NR, De Aquino JP, MacLean RR, Sofuoglu M. Cocaine Use Disorder (CUD): Current Clinical Perspectives. Subst Abuse Rehabil 2022; 13:25-46. [PMID: 36093428 PMCID: PMC9451050 DOI: 10.2147/sar.s337338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic effects of cocaine use, and currently available pharmacological and behavioral treatments. There are no FDA-approved pharmacological treatments for CUD. Future studies with larger sample sizes and testing treatment combinations are warranted. However, individuals with CUD and co-occurring disorders (eg, a mood or anxiety disorder) may benefit from medication treatments. There are behavioral interventions that have demonstrated efficacy in treating CUD – contingency management (CM) and cognitive-behavioral therapy for substance use disorders (CBT-SUD) in particular – however many barriers remain in delivering these treatments to patients. Following the discussion of current treatments, we highlight some promising emerging treatments, as well as offer a framework that can be used in building a treatment plan for individuals with CUD.
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Affiliation(s)
- Elizabeth K C Schwartz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
- Correspondence: Elizabeth KC Schwartz, Tel +1-203-932-5711, Fax +1-203-937-3472, Email
| | - Noah R Wolkowicz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - R Ross MacLean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
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Carlon HA, Hurlocker MC, Witkiewitz K. Mechanisms of quality-of-life improvement in treatment for alcohol use disorder. J Consult Clin Psychol 2022; 90:601-612. [PMID: 36066862 PMCID: PMC9899433 DOI: 10.1037/ccp0000750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE For individuals in alcohol use disorder (AUD) treatment, many argue that holistic indicators such as quality of life (QoL) should be more consistently used in addition to drinking-related indicators. QoL increases from pre- to post-AUD treatment, but the mechanisms are unclear. The present study examined the roles of positive and negative affect in QoL change during AUD treatment and additionally explored the relationship between QoL change and medication adherence. METHOD We examined the mediating roles of end-of-treatment positive affect (i.e., vigor) and negative affect (i.e., stress and tension) in the relationship between baseline (BL) and 26-week QoL among participants in the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence study randomized to medication management (MM; n = 468) or medication management plus combined behavioral intervention (MMCBI; n = 479) for AUD. We also explored whether changes in QoL were associated with medication adherence. RESULTS Change in psychological health QoL was mediated by increased vigor (i.e., positive affect) and decreased stress, and change in environmental QoL was mediated by decreased stress. There were also differences by treatment group, with stress mediating changes in environmental QoL among participants in MM, and vigor mediating changes in psychological health QoL among participants in MMCBI. Medication adherence was not associated with greater QoL after controlling for posttreatment alcohol use. CONCLUSIONS The present study identified potential mechanisms of QoL change in AUD treatment, thus contributing to the growing knowledge surrounding alternative indicators of treatment success for AUD treatment and recovery. Targeting affective states and stress during treatment may improve QoL and recovery outcomes for persons with AUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Hannah A. Carlon
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Department of Psychology, Albuquerque, NM, 87131, USA
| | - Margo C. Hurlocker
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Department of Psychology, Albuquerque, NM, 87131, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Department of Psychology, Albuquerque, NM, 87131, USA
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Baer MM, Tull MT, Gratz KL. Substance Use Frequency Relates to Suicidal Ideation Through Perceived Burdensomeness and to Suicide Attempts Through Capability for Suicide. Arch Suicide Res 2022; 26:1520-1540. [PMID: 34529923 DOI: 10.1080/13811118.2021.1931595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although substance use has been linked to both suicidal ideation and suicide attempts, the factors underlying these relations remain unclear. The Interpersonal-Psychological Theory of Suicide (ITS) provides a framework for understanding how substance use may increase suicide risk. The purpose of the current study was to examine if frequency of substance use is indirectly related to suicidal ideation and suicide attempts through core ITS variables (i.e., burdensomeness, thwarted belongingness, and suicide capability). METHODS An online sample of Mechanical Turk workers (N = 365) completed measures assessing substance use frequency, burdensomeness, thwarted belongingness, suicide capability, suicidal ideation, and suicide attempts. RESULTS After controlling for relevant clinical and demographic covariates, substance use frequency was indirectly related to suicidal ideation through burdensomeness but not thwarted belongingness. Substance use frequency was indirectly related to suicide attempts through suicide capability only. LIMITATIONS The cross-sectional design precludes conclusions about the precise nature and direction of the relations examined. The use of a community sample limits generalizability to more severe substance using samples. CONCLUSIONS Results highlight the relevance of distinct ITS factors in the relation between substance use frequency and both suicidal ideation and suicide attempts. Results may inform specific targets for novel interventions aimed at reducing suicide risk among substance-using individuals.HighlightsSubstance use frequency was indirectly related to SI through burdensomeness.Substance use frequency was not indirectly related to SI through thwarted belongingness.Substance use frequency was indirectly related to SA only through suicide capability.
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Kotz D, O'Donnell A, McPherson S, Thomas KH. Using primary care databases for addiction research: An introduction and overview of strengths and weaknesses. Addict Behav Rep 2022; 15:100407. [PMID: 35111898 PMCID: PMC8789598 DOI: 10.1016/j.abrep.2022.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022] Open
Abstract
Primary care databases extract and combine routine data from the electronic patient records of various participating practices on a regular basis. These databases can be used for innovative and relevant addiction research, but such use requires a thorough understanding of how data were originally collected and how they need to be processed and statistically analysed to produce sound scientific evidence. The aims of this paper are therefore to (1) make a case for why primary care databases should be considered more frequently for addiction research; (2) provide an overview of how primary care databases are constructed; (3) highlight important methodological and statistical strengths and weaknesses of using primary care databases for research; and (4) give practical advice about how a researcher can get access to databases. Three major primary care databases from the UK serve as examples: Clinical Practice Research Datalink (CPRD), The Health Improvement Network (THIN), and QResearch.
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich‐Heine‐University Düsseldorf, Germany
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sterling McPherson
- Program of Excellence in Addictions Research and the Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Elson S. Floyd College of Medicine, USA
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Gendera S, Treloar C, Reilly R, Conigrave KM, Butt J, Roe Y, Ward J. 'Even though you hate everything that's going on, you know they are safer at home': The role of Aboriginal and Torres Strait Islander families in methamphetamine use harm reduction and their own support needs. Drug Alcohol Rev 2022; 41:1428-1439. [PMID: 35639622 PMCID: PMC9546040 DOI: 10.1111/dar.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 12/02/2022]
Abstract
Introduction First Nations people who use methamphetamine are overrepresented in regional and remote Australia and more likely to turn to family for support. This can place strain on families. The support needs of family members of individuals using methamphetamine are poorly understood. Methods We conducted 19 focus groups and seven interviews with mostly First Nations community, family members and service providers. In total, 147 participants across six sites participated as part of a larger study investigating First Nations perspectives of how to address methamphetamine use and associated harms. We applied a social and emotional wellbeing framework to examine support needs and role of family in mitigating methamphetamine harms. Results Findings highlighted the importance of families in providing support to people using methamphetamine and in reducing associated harms, often without external support. The support provided encompassed practical, social, emotional, financial, access to services and maintaining cultural connection. Providing support took a toll on family and negatively impacted their own social and emotional wellbeing. Discussion and Conclusions First Nations families play an important and under‐recognised role in reducing methamphetamine‐related harms and greater efforts are required to support them. Professional resources are needed to deal with impacts of methamphetamine on families; these should be pragmatic, accessible, targeted and culturally appropriate. Support for families and communities should be developed using the social and emotional wellbeing framework that recognises wellbeing and healing as intrinsically connected to holistic health, kinship, community, culture and ancestry, and socioeconomic and historical influences on peoples' lives.
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Affiliation(s)
- Sandra Gendera
- Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health and Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Rachel Reilly
- Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Katherine M Conigrave
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Julia Butt
- National Drug Research Institute, Curtin University, Perth, Australia.,Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Yvette Roe
- College of Nursing & Midwifery, Charles Darwin University, Brisbane, Australia
| | - James Ward
- Poche Centre for Indigenous Health, School of Public Health, The University of Queensland, Brisbane, Australia
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Boucher LM, Shoemaker ES, Liddy CE, Leonard L, MacPherson PA, Presseau J, Martin A, Pineau D, Lalonde C, Diliso N, Lafleche T, Fitzgerald M, Kendall CE. "The Drug Use Unfortunately isn't all Bad": Chronic Disease Self-Management Complexity and Strategy Among Marginalized People Who Use Drugs. QUALITATIVE HEALTH RESEARCH 2022; 32:871-886. [PMID: 35324352 PMCID: PMC9189593 DOI: 10.1177/10497323221083353] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Self-management programs improve health outcomes and self-management is recommended for chronic conditions. Yet chronic disease self-management supports have rarely been applied to people who use drugs (PWUD). Thus, our objective was to explore self-management experiences among marginalized PWUD. We used community-based participatory methods and conducted qualitative interviews. Participants self-identified as having long-term and past year experience using non-prescribed drugs, one other chronic condition, and socioeconomic marginalization. We analyzed the data using reflexive thematic analysis. Although many participants considered drug use a chronic health issue, self-medicating with non-prescribed drugs was also a key self-management strategy to address other health issues. Participants also described numerous other strategies, including cognitive and behavioral tactics. These findings highlight the need for a safe supply of pharmaceutical-grade drugs to support self-management among marginalized PWUD. Self-management supports should also be tailored to address relevant topics (e.g., harm reduction, withdrawal), include creative activities, and not hinder PWUD's agency.
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Affiliation(s)
- Lisa M. Boucher
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Lisa M. Boucher, Elisabeth Bruyere Research Institute, 43 Bruyere Street, Annex E, Ottawa, ON K1N 5C7, Canada.
| | - Esther S. Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Clare E. Liddy
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lynne Leonard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paul A. MacPherson
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alana Martin
- Somerset West Community Health Centre, Ottawa, ON, Canada
- Centretown Community Health Centre, Ottawa, ON, Canada
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Dave Pineau
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Christine Lalonde
- Centretown Community Health Centre, Ottawa, ON, Canada
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Nic Diliso
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
| | - Terry Lafleche
- The CDSM Among PWUD Study’s Community Advisory Committee, Bruyère Research Institute, Ottawa, ON, Canada
- Sandy Hill Community Health Centre, Ottawa, ONCanada
| | - Michael Fitzgerald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Claire E. Kendall
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Gueorguieva R, Schwartz EKC, MacLean RR, DeVito EE, Eid T, Wu R, O’Malley SS, Sofuoglu M. Plasma Menthol Glucuronide as a Biomarker for the Behavioral Effects of Menthol and Nicotine in Humans. Front Pharmacol 2022; 13:844824. [PMID: 35431934 PMCID: PMC9009207 DOI: 10.3389/fphar.2022.844824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/08/2022] [Indexed: 11/30/2022] Open
Abstract
This secondary analysis sought to determine if plasma menthol glucuronide (MG) concentrations predict changes in three outcomes, subjective drug effects, urges to smoke, and heart rate, following concurrent inhaled menthol and intravenous nicotine. A total of 45 menthol and non-menthol cigarettes smokers (36 male, nine female, 20 Black, and 23 White) were included in this double-blind, placebo-controlled study. Across three test sessions, participants were assigned to a different flavor condition for each session: 0% (no menthol), 0.5%, or 3.2% menthol. In each test session, participants received in a random order one intravenous delivery of saline and two intravenous deliveries of nicotine (0.25 mg/70 kg and 0.5 mg/70 kg), each 1 h apart, concurrent with menthol delivery by e-cigarettes. The main outcomes were subjective drug effects, urges to smoke, and heart rate. The results showed that following e-cigarette inhalation, changes in plasma MG concentrations or “menthol boost” increased proportionally to the menthol concentration in the e-liquids. While changes in plasma MG concentrations were not predictive of increases in heart rate or subjective drug effects that are reflective of acute effects from nicotine (i.e., feel good effects, stimulated, aversive effects), they were predictive of cooling effect, a typical effect of menthol, but only in menthol smokers in the absence of concurrent active nicotine infusion. These findings demonstrate the utility of plasma MG as a biomarker both for acute menthol exposure by e-cigarette inhalation and for the examination of the concentration-dependent behavioral and physiological effects of menthol in humans.
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Affiliation(s)
- Ralitza Gueorguieva
- Yale School of Public Health, Department of Biostatistics, New Haven, CT, United States
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States
| | - Elizabeth K. C. Schwartz
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States
- VA Connecticut Healthcare System, West Haven, CT, United States
| | - R. Ross MacLean
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States
- VA Connecticut Healthcare System, West Haven, CT, United States
| | - Elise E. DeVito
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States
| | - Tore Eid
- Yale University, School of Medicine, Department of Laboratory Medicine, New Haven, CT, United States
| | - Ran Wu
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States
| | - Stephanie S. O’Malley
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States
| | - Mehmet Sofuoglu
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, United States
- VA Connecticut Healthcare System, West Haven, CT, United States
- *Correspondence: Mehmet Sofuoglu,
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Abbott P, Watt K, Magin P, Davison J, Hu WCY. Welcomeness for people with substance use disorders to general practice: a qualitative study. Fam Pract 2022; 39:257-263. [PMID: 34791184 DOI: 10.1093/fampra/cmab151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Good primary care for people with substance use disorders (SUDs) is crucial given the high prevalence of SUDs and overdose deaths. OBJECTIVE To explore general practice care for people with a history of SUDs from the perspectives of women involved with the criminal justice system. METHODS Qualitative interview study with pre- and postrelease interviews, undertaken in Australian prisons and community settings. We utilized thematic analysis informed by constructivist grounded theory. RESULTS We undertook 65 interviews with 39 women. Access to and experience of general practitioner (GP) care was affected by perceived welcomeness, decisions around disclosure, and consultation experiences related to medication prescription. Participants reported that they were not as welcome as other patients, welcome could be conditional on not disclosing SUDs or only requesting unrelated healthcare, and GPs did not always differentiate between past and current drug use. Participants perceived difficulty finding general practices where the potential benefit of disclosing SUDs outweighed the risks of stigmatized reactions and lack of GP skills and interest. Participants did not always recognize that care beyond physical health could occur in general practice. The pejorative implications of labelling patients as "doctor shoppers" were challenged by participants, as they considered it could be necessary to attend multiple GPs to find a welcoming practice. CONCLUSIONS People with histories of SUDs do not uniformly experience welcomeness in general practice, perpetuating poor engagement in healthcare and poor outcomes related to SUDs. Programmes targeting prescription drug misuse through general practice should also promote welcomeness for people with SUDs.
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Affiliation(s)
- Penelope Abbott
- Department of General Practice, School of Medicine, Western Sydney University, Sydney, Australia
| | - Kelly Watt
- Aboriginal and Torres Strait Islander Community Health Service, Brisbane, Australia
| | - Parker Magin
- Discipline of General Practice, University of Newcastle, Newcastle, Australia
| | | | - Wendy C Y Hu
- Medical Education Unit, School of Medicine, Western Sydney University, Sydney, Australia
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Matheson FI, Hamilton-Wright S, Hahmann T, McLuhan A, Tacchini G, Wendaferew A, Dastoori P. Filling the GAP: Integrating a gambling addiction program into a shelter setting for people experiencing poverty and homelessness. PLoS One 2022; 17:e0264922. [PMID: 35290379 PMCID: PMC8923431 DOI: 10.1371/journal.pone.0264922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 02/18/2022] [Indexed: 11/18/2022] Open
Abstract
The burden of harm from problem gambling weighs heavily on those experiencing poverty and homelessness, yet most problem gambling prevention and treatment services are not designed to address the complex needs and challenges of this population. To redress this service gap, a multi-service agency within a shelter setting in a large urban centre developed and implemented a population-tailored, person-centred, evidence-informed gambling addiction program for its clients. The purpose of this article is to report on qualitative findings from an early evaluation of the program, the first designed to address problem gambling for people experiencing poverty and/or homelessness and delivered within a shelter service agency. Three themes emerged which were related to three program outcome categories. These included increasing awareness of gambling harms and reducing gambling behaviour; reorienting relationships with money; and, seeking, securing, and stabilizing shelter. The data suggest that problem gambling treatment within the context of poverty and homelessness benefits from an approach and setting that meets the unique needs of this community. The introduction of gambling treatment into this multi-service delivery model addressed the complex needs of the service users through integrated and person-centered approaches to care that responded to client needs, fostered therapeutic relationships, reduced experiences of discrimination and stigma, and enhanced recovery. In developing the Gambling Addiction Program, the agency drew on evidence-based approaches to problem gambling treatment and extensive experience working with the target population. Within a short timeframe, the program supported participants in the process of recovery, enhancing their understanding and control of their gambling selves, behaviours, and harms. This project demonstrates that gambling within the context of poverty requires a unique treatment space and approach.
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Affiliation(s)
- Flora I. Matheson
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Centre for Criminology & Sociolegal Studies, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Hamilton-Wright
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Tara Hahmann
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Arthur McLuhan
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Guido Tacchini
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Parisa Dastoori
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Centre for Criminology & Sociolegal Studies, University of Toronto, Toronto, Ontario, Canada
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Spread of gambling abstinence through peers and comments in online self-help chat forums to quit gambling. Sci Rep 2022; 12:3675. [PMID: 35256679 PMCID: PMC8901770 DOI: 10.1038/s41598-022-07714-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/22/2022] [Indexed: 11/08/2022] Open
Abstract
Habit formation occurs in relation to peer habits and comments. This general principle was applied to gambling abstinence in the context of online self-help forums to quit gambling. Participants in this study, conducted between September 2008 and March 2020, were 161 abstinent and 928 non-abstinent gamblers who participated in online self-help chat forums to quit gambling. They received 269,317 comments during their first 3 years of forum participation. Gamblers had an increased likelihood of 3-year continuous gambling abstinence if they had many peers in the forums. However, they had a decreased likelihood of gambling abstinence if they received rejective comments from the forums. Based on these results, online social network-based interventions may be a new treatment option for gamblers.
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Filiz N, Polat S. The correlation between the addiction profile and general self-efficacy of patients receiving treatment for substance use disorder. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2047808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nupel Filiz
- Generel Intensıve Care Department, Izmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Sibel Polat
- Faculty of Health Sciences, Department of Psychiatric Nursing, SANKO University, Gaziantep, Turkey
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Carswell SB, Gordon MS, Gryczynski J, Taxman FS, Schadegg M, Ferguson KN, Maher K. Continuing Care App for Probationers and Parolees with Substance use Disorders. JOURNAL OF DRUG EDUCATION 2022; 51:32-48. [PMID: 35832032 DOI: 10.1177/00472379221111541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This pilot proof-of-concept study examined the feasibility and acceptability of a Continuing Care mobile application (app) designed to meet the recovery and personal support needs of individuals under justice supervision who were receiving outpatient substance use disorder (SUD) treatment. The study included adults on probation or parole who were enrolled in an outpatient SUD treatment program (N = 15; 86.7% males). Participants were instructed to utilize the Continuing Care app daily for 4 weeks. At the end of the study, they completed a satisfaction questionnaire. Of the 15 participants enrolled in the study, 12 (80%) completed the Continuing Care app modules and the satisfaction questionnaire, and all of these participants indicated high levels of satisfaction with the app (on a scale of 1-10, Mean = 1.8, SD = 1.2). The Continuing Care app was well-utilized and perceived as valuable by this group of low-income, underserved, and hard-to-reach individuals. Further research is needed to refine app content and evaluate its ability to meaningfully enhance and extend the benefits of SUD treatment.
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Affiliation(s)
| | | | | | | | - Mary Schadegg
- 8083The University of Mississippi, University, MS, USA
| | | | - Kelly Maher
- 215392Friends Research Institute, Baltimore, MD, USA
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Brookfield S, Selvey L, Maher L, Fitzgerald L. ‘Making Ground’: An Ethnography of ‘Living With’ Harmful Methamphetamine Use and the Plurality of Recovery. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426211073911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The trajectories of people attempting to reduce harmful methamphetamine use are frequently understood within a binary framework of transitioning between states of health and disease. This framework can often be reinforced by service interactions informed by these dominant narratives of recovery and addiction. In this paper, we draw on a critical interactionist analysis of ethnographic fieldwork conducted with people who use methamphetamine, to examine how their experiences could undermine this binary, observing the ways participants experienced growth, change, and progress, without necessarily maintaining abstinence. These findings support a more diverse understanding of drug use trajectories, and we explore the concept of ‘living with drug use’, similar to how people live with other chronic conditions by finding ‘health in illness’. Participant experiences are also interpreted within the context of counter public health, arguing for the recognition and integration of values and goals which are divergent from the implicit aims of public health practice.
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Affiliation(s)
- Samuel Brookfield
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Linda Selvey
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Lisa Fitzgerald
- School of Public Health, The University of Queensland, Brisbane, Australia
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36
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Chanen AM, Betts JK, Jackson H, Cotton SM, Gleeson J, Davey CG, Thompson K, Perera S, Rayner V, Chong SY, McCutcheon L. A Comparison of Adolescent versus Young Adult Outpatients with First-Presentation Borderline Personality Disorder: Findings from the MOBY Randomized Controlled Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:26-38. [PMID: 33576244 PMCID: PMC8811246 DOI: 10.1177/0706743721992677] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The increasing focus on adolescent personality disorder has tended to ignore evidence of the developmental continuity of the period from puberty to young adulthood. This study aims to: (1) describe the characteristics of a sample of young people with borderline personality disorder (BPD) who had no previous history of evidence-based treatment for the disorder and (2) compare their characteristics by participant age group. METHODS One hundred and thirty-nine young people (15 to 25 years) with BPD, newly enrolled in the Monitoring Outcomes of BPD in Youth randomized controlled trial, completed semi-structured interview and self-report measures assessing demographic, clinical, and functional characteristics. Younger (aged 15 to 17 years; n = 64) and older (aged 18 to 25 years; n = 75) participants were compared on these same variables using t-tests, chi-square tests, and logistic regression. RESULTS Young outpatients with BPD had extensive and severe psychopathology and were functioning poorly. Adolescents and young adults with BPD showed substantial similarities on 20 key aspects of their presentation. Significant between-groups differences were observed in household makeup, treatment history, antisocial personality disorder, emotion dysregulation, substance use, age of commencement and extent of self-harm, and achievement of age-appropriate educational milestones. Adolescent BPD group membership was predicted by family composition and self-harm, whereas young adult BPD group membership was predicted by not achieving age-appropriate milestones, vocational disengagement, and emotion dysregulation. The final model explained 54% of the variance and correctly classified 80.2% of the sample by age. CONCLUSIONS Both adolescents and young adults with early stage BPD present with severe and often similar problems to one another, supporting developmental continuity across this age range. However, there are also meaningful differences in presentation, suggesting that pathways to care might differ by age and/or developmental stage. Detection and intervention for personality disorder should not be delayed until individuals reach 18 years of age.
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Affiliation(s)
- Andrew M Chanen
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Jennifer K Betts
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Sue M Cotton
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne Campus, Australia
| | - Christopher G Davey
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia.,Department of Psychiatry, The University of Melbourne, Australia
| | - Katherine Thompson
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Sharnel Perera
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Victoria Rayner
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Sinn Yuin Chong
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
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Parkinson's Disease-Related Biomarkers That May Appear in Amphetamine Abusers. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3081891. [PMID: 34712729 PMCID: PMC8548088 DOI: 10.1155/2021/3081891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/12/2021] [Accepted: 09/18/2021] [Indexed: 01/17/2023]
Abstract
Parkinson's disease (PD) is one of the most common neurodegenerative disorders. Amphetamine addiction may cause serious of psychotic and physical damage to humans. There is some evidence that shows that amphetamine may increase the risk of PD. Thus, this study is aimed at comparing the PD serum biomarkers between amphetamine addicts and PD patients and utilizing them as diagnostic biomarkers for the early detection of PD incidence among amphetamine addicts. In the current study, nineteen amphetamine addicts, aged <40, were recruited from the Al Amal Psychiatric hospital, Jazan, Saudi Arabia. Nineteen PD patients and 19 healthy controls, who have never taken amphetamine, were also recruited. Blood samples were withdrawn from all groups. A biomarker multiplex assay from MILLIPLEX was used to assess the levels of serum amyloid-P (SAP), complement C4, C-reactive protein (CRP), and CRP/albumin ratio in serum samples (Vitros 350® slide was used to assess the albumin). All data were statistically analyzed using one-way ANOVA. The results showed that SAP and CRP levels were significantly higher in amphetamine addicts compared to healthy controls (p = 0.0001 and p = 0.0001, respectively). The results of amphetamine addicts were comparable to PD levels. However, there are no significant differences between all studied groups concerning complement C4 level. Moreover, albumin levels were significantly decreased and CRP/Albumin ratio levels were significantly increased in amphetamine addicts (p = 0.01 and p = 0.041, respectively) in contrast with controls. These findings indicate that the increased level of these inflammatory biomarkers (SAP and CRP) in the amphetamine addicts may give a potential possibility of their serum level to be used as screening markers to detect PD development in the amphetamine addict. It may be useful to evaluate the changes in easily accessible and cost-effective parameters such as the serum CRP/albumin ratio.
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Pouliquen M, Auriacombe M. Psychotherapeutic interventions for cannabis use disorder. What do we know and what should we do? Encephale 2021; 48:70-77. [PMID: 34625215 DOI: 10.1016/j.encep.2021.05.009] [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: 04/07/2021] [Accepted: 05/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cannabis use disorder is the most commonly reported illegal substance use disorder and demand for treatment is growing worldwide. OBJECTIVES Our aim was to compare the two last Cochrane systematic reviews of the literature concerning psychotherapeutic and psychosocial interventions for cannabis use disorder to determine what new evidence emerged and how craving was considered as a treatment mediator. METHOD We extracted raw data from both reviews regarding their titles, objectives, methods and results. This information was analyzed by face validity to distinguish apparent differences from real differences. It enabled us to describe similarities and differences between reviews. We also screened both reviews looking for craving or related words. RESULTS The objective and methods of both reviews were mostly similar. Although the second review covered a wider range of psychotherapies, including drug counseling and mindfulness-based meditation as an intervention group and minimal treatment as a control group. Five of the six studies included in the first review were also included in the second review. One study excluded from the first review was included in the last review that included an additional 17 studies published after the first review. The 2016 review performed a meta-analysis whereas the first review was descriptive. Both reviews supported the efficacy of motivational enhancement therapy and cognitive and behavioral therapy interventions with adjunction of contingency management for abstinence when possible. There was no relevant mention of craving in the 2006 review and very few in the 2016 review. CONCLUSION The methods and results of the last two Cochrane reviews on psychosocial interventions for cannabis use disorder were mostly similar. Consistent with other reviews on the same subject and reviews of psychotherapies for other substance use disorders, the 2016 review confirmed evidence already available in the 2006 review. Instead of confirming already confirmed evidence, future research is needed to determine if craving focused treatment would increase efficiency and how to maintain initial treatment outcomes long-term.
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Affiliation(s)
- M Pouliquen
- University of Bordeaux, 33000 Bordeaux, France; Équipe phénoménologie et déterminants des comportements appétitifs, Sanpsy CNRS USR 3413, University of Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France
| | - M Auriacombe
- University of Bordeaux, 33000 Bordeaux, France; Équipe phénoménologie et déterminants des comportements appétitifs, Sanpsy CNRS USR 3413, University of Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France.
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Costello MJ, Li Y, Zhu Y, Walji A, Sousa S, Remers S, Chorny Y, Rush B, MacKillop J. Using conventional and machine learning propensity score methods to examine the effectiveness of 12-step group involvement following inpatient addiction treatment. Drug Alcohol Depend 2021; 227:108943. [PMID: 34390964 DOI: 10.1016/j.drugalcdep.2021.108943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Continuing care following inpatient addiction treatment is an important component in the continuum of clinical services. Mutual help, including 12-step groups like Alcoholics Anonymous, is often recommended as a form of continuing care. However, the effectiveness of 12-step groups is difficult to establish using observational studies due to the risks of selection bias (or confounding). OBJECTIVE To address this limitation, we used both conventional and machine learning-based propensity score (PS) methods to examine the effectiveness of 12-step group involvement following inpatient treatment on substance use over a 12-month period. METHODS Using data from the Recovery Journey Project - a longitudinal, observational study - we followed an inpatient sample over 12-months post-treatment to assess the effect of 12-step involvement on substance use at 12-months (n = 254). Specifically, PS models were constructed based on 34 unbalanced confounders and four PS-based methods were applied: matching, inverse probability weighting (IPW), doubly robust (DR) with matching, and DR with IPW. RESULTS Each PS-based method minimized the potential of confounding from unbalanced variables and demonstrated a significant effect (p < 0.001) between high 12-step involvement (i.e., defined as having a home group; having a sponsor; attending at least one meeting per week; and, being involved in service work) and a reduced likelihood of using substances over the 12-month period (odds ratios 0.11 to 0.32). CONCLUSIONS PS-based methods effectively reduced potential confounding influences and provided robust evidence of a significant effect. Nonetheless, results should be considered in light of the relatively high attrition rate, potentially limiting their generalizability.
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Affiliation(s)
| | - Yao Li
- Homewood Research Institute, Guelph, ON, Canada
| | - Yeying Zhu
- Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Alyna Walji
- Homewood Research Institute, Guelph, ON, Canada; Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, ON, Canada
| | - Sarah Sousa
- Homewood Research Institute, Guelph, ON, Canada
| | | | | | - Brian Rush
- Homewood Research Institute, Guelph, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - James MacKillop
- Homewood Research Institute, Guelph, ON, Canada; Peter Boris Centre for Addiction Research, McMaster University & St. Joseph's Health Care, Hamilton, ON, Canada
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Stanojlović M, Davidson L. Targeting the Barriers in the Substance Use Disorder Continuum of Care With Peer Recovery Support. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:1178221820976988. [PMID: 34211275 PMCID: PMC8216338 DOI: 10.1177/1178221820976988] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/31/2020] [Indexed: 11/15/2022]
Abstract
Substance Use Disorder (SUD) has been recognized as a chronic, relapsing disorder. However, much of existing SUD care remains based in an acute care model that focuses on clinical stabilization and discharge, failing to address the longer-term needs of people in recovery from addiction. The high rates of client’s disengagement and attrition across the continuum of care highlight the need to identify and overcome the obstacles that people face at each stage of the treatment and recovery process. Peer recovery support services (PRSS) show promise in helping people initiate, pursue, and sustain long-term recovery from substance-related problems. Based on a comprehensive review of the literature, the goal of this article is to explore the possible roles of peers along the SUD care continuum and their potential to improve engagement in care by targeting specific barriers that prevent people from successfully transitioning from one stage to the next leading eventually to full recovery. A multidimensional framework of SUD care continuum was developed based on the adapted model of opioid use disorder cascade of care and recovery stages, within which the barriers known to be associated with each stage of the continuum were matched with the existing evidence of effectiveness of specific PRSSs. With this conceptual paper, we are hoping to show how PRSSs can become a complementary and integrated part of the system of care, which is an essential step toward improving the continuity of care and health outcomes.
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Affiliation(s)
- Milena Stanojlović
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Larry Davidson
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
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Kaskela T, Pitkänen T. Association between the discontinuation of substance use inpatient treatment and the risk of committing a crime leading to imprisonment: A Finnish registry-based 5-year follow-up. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2021; 31:171-182. [PMID: 33950557 DOI: 10.1002/cbm.2198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Discontinuation of substance use inpatient treatment is common, generally due to dropout and rule breaking. In turn, this is associated with worse long-term substance use outcomes. AIM To investigate whether people who discontinued voluntary inpatient substance use treatment have a higher risk of imprisonment for a crime within 5 years of discontinuance than those who completed treatment. METHODS This registry-based follow-up study focused on all inpatient treatment episodes between 2002 and 2009 (N = 2893) in a Finnish hospital for treating addictions. Data from national registers on criminality, hospitalisations and education were linked. Cox regression analysis was used. RESULTS Discontinued treatment episodes were 1.4 times more likely to be followed by criminality leading to imprisonment during the 5-year follow-up period compared with completed treatment periods, after adjusting for age, gender, education, substance use diagnoses, earlier mental health disorders and prior imprisonments. CONCLUSIONS Our findings strengthen the argument for ensuring completion of substance use treatment episodes; better completion rates could decrease the harm caused by serious criminality. Indeed, we recommend that crime reduction should be included to the long-term goals of substance use treatment.
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Affiliation(s)
- Teemu Kaskela
- Department of Social Research, University of Helsinki, Helsinki, Finland
- A-Clinic Foundation, Helsinki, Finland
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42
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Howell A, Lambert A, Pinkston MM, Blevins CE, Hayaki J, Herman DS, Moitra E, Stein MD, Kim HN. Sustained Sobriety: A Qualitative Study of Persons with HIV and Chronic Hepatitis C Coinfection and a History of Problematic Drinking. AIDS Behav 2021; 25:1083-1093. [PMID: 33064248 PMCID: PMC7979443 DOI: 10.1007/s10461-020-03067-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 12/16/2022]
Abstract
For persons diagnosed with HIV and who are coinfected with hepatitis C virus (HCV), chronic liver disease is a leading cause of death and excessive consumption of alcohol can be a contributing factor. Little is known about the factors these individuals identify as key to achieving sustained sobriety. In this qualitative study, fourteen HIV/HCV coinfected persons who endorsed past problematic drinking were interviewed about their path to sustained sobriety. In open-ended interviews, participants often described their drinking in the context of polysubstance use and their decision to become sober as a singular response to a transcendent moment or a traumatic event. All articulated specific, concrete strategies for maintaining sobriety. The perceived effect of the HIV or HCV diagnosis on sobriety was inconsistent, and medical care as an influence on sobriety was rarely mentioned. Qualitative interviews may offer new insights on interventions and support strategies for heavy-drinking persons with HIV/HCV coinfection.
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Affiliation(s)
- Abigail Howell
- Department of Medicine, University of Washington, 325 Ninth Avenue Box 359930, Seattle, WA, 98104, USA
| | - Audrey Lambert
- Section of General Internal Medicine, CARE Unit, Boston Medical Center, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Megan M Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Claire E Blevins
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jumi Hayaki
- Department of Psychology, College of the Holy Cross, Worcester, MA, USA
| | - Debra S Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - H Nina Kim
- Department of Medicine, University of Washington, 325 Ninth Avenue Box 359930, Seattle, WA, 98104, USA.
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Jason LA, Salomon-Amend M, Guerrero M, Bobak T, O'Brien J, Soto-Nevarez A. The Emergence, Role, and Impact of Recovery Support Services. Alcohol Res 2021; 41:04. [PMID: 33796431 PMCID: PMC7996242 DOI: 10.35946/arcr.v41.1.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Various community recovery support services help sustain positive behavior change for individuals with alcohol and drug use disorders. This article reviews the rationale, origins, emergence, prevalence, and empirical research on a variety of recovery support services in U.S. communities that may influence the likelihood of sustained recovery. The community recovery support services reviewed include recovery high schools, collegiate recovery programs, recovery homes, recovery coaches, and recovery community centers. Many individuals are not provided with the types of environmental supports needed to solidify and support their recovery, so there is a need for more research on who may be best suited for these services as well as when, why, and how they confer benefit.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, Chicago, Illinois
| | | | - Mayra Guerrero
- Center for Community Research, DePaul University, Chicago, Illinois
| | - Ted Bobak
- Center for Community Research, DePaul University, Chicago, Illinois
| | - Jack O'Brien
- Center for Community Research, DePaul University, Chicago, Illinois
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Winters DE, Brandon-Friedman R, Yepes G, Hinckley JD. Systematic review and meta-analysis of socio-cognitive and socio-affective processes association with adolescent substance use. Drug Alcohol Depend 2021; 219:108479. [PMID: 33444900 PMCID: PMC7943258 DOI: 10.1016/j.drugalcdep.2020.108479] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Social impairments are important features of a substance use disorder diagnosis; and recent models suggest early impairments in socio-cognitive and -affective processes may predict future use. However, no systematic reviews are available on this topic. METHODS We conducted a systematic review and meta-analyses exploring the association between social-cognitive and -affective processes (empathy, callous-unemotional (CU) traits, theory of mind, and social cognition) and substance use frequency (alcohol, cannabis, general drug use). We examined moderating effects of study design, gender, age, and weather conduct problems were controlled for. We also review brain studies related to social cognition and substance use disorder (SUD) risk. RESULTS Systematic review suggested a negative association for positively valenced constructs with substance use but mixed results on the negatively valenced construct CU traits. Meta-analyses revealed moderate positive association between CU traits with alcohol and general drug use but no significance with cannabis use. Moderate effect sizes were found for CU traits in youth predicting severity of substance use by late adolescence and significantly accounted for variance independently of conduct problems. Significant moderators included gender proportions, sample type, and age. Neuroimaging meta-analysis indicated 10 coordinates that were different in youth at a high risk/with SUD compared to controls. Three of these coordinates associate with theory of mind and social cognition. CONCLUSION Socio-cognitive and -affective constructs demonstrate an association with current and future substance use, and neural differences are present when performing social cognitive tasks in regions with strongest associations with theory of mind and social cognition.
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Affiliation(s)
- Drew E Winters
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States.
| | | | - Gabriel Yepes
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States
| | - Jesse D Hinckley
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States
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Abstract
Continuing care is widely believed to be an important component of effective treatment for substance use disorder, particularly for those individuals with greater problem severity. The purpose of this review was to examine the research literature on continuing care for alcohol and drug use disorders, including studies that addressed efficacy, moderators, mechanisms of action, and economic impact. This narrative review first considered findings from prior reviews (published through 2014), followed by a more detailed examination of studies published more recently. The review found that research has generally supported the efficacy of continuing care for both adolescents and adults, but the picture is complex. Reviews find relatively small effects when results from individual studies are combined. However, continuing care of longer duration that includes more active efforts to keep patients engaged may produce more consistently positive results. Moreover, patients at higher risk for relapse may benefit to a greater degree from continuing care. Several newer approaches for the provision of continuing care show promise. These include incentives for abstinence and automated mobile health interventions to augment more conventional counselor-delivered interventions. Primary care can be used to provide medications for opioid and alcohol use disorders over extended periods, although more research is needed to determine the optimal mix of behavioral treatments and other psychosocial services in this setting. Regardless of the intervention selected for use, the status of most patients will change and evolve over time, and interventions need to include provisions to assess patients on a regular basis and to change or adapt treatment when warranted.
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Affiliation(s)
- James R McKay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania. Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Dogan J, Stevens-Watkins D, Knighton JS, Wheeler P, Hargons C. Perceived need for drug treatment among African American male drug-using prisoners. J Subst Abuse Treat 2021; 120:108166. [PMID: 33298302 PMCID: PMC7733029 DOI: 10.1016/j.jsat.2020.108166] [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: 02/17/2020] [Revised: 06/30/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Since 2016, African Americans have experienced the largest increase in cocaine-related drug overdose deaths compared to other racial/ethnic groups. African American male prisoners who used drugs prior to incarceration are at an increased risk for relapse and overdose upon community re-entry. Using the Theory of Planned Behavior as a guiding framework, this study examined correlates of perceived need for treatment among 193 drug-using incarcerated African American men nearing release. Linear regression analyses revealed that the number of lifetime drug overdoses, severity of legal problems, and previous drug treatment significantly predicted a need for treatment. Further, more frequent drug use, specifically crack cocaine, in the month prior to incarceration predicted a higher perceived need for drug treatment. Implications suggest this population demonstrates a need for treatment, which may be exacerbated by re-entry stressors. Preventative measures, including culturally tailored treatment and transitional care from prison to community-based services, are necessary to reduce risk of relapse and overdose among this group.
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Affiliation(s)
- Jardin Dogan
- University of Kentucky, Department of Educational, School, and Counseling Psychology, , 36 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Danelle Stevens-Watkins
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 235 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Joi-Sheree Knighton
- Center for Forensic Psychiatry, Michigan Department of Health and Human Services (MDHHS), P.O. Box 2060, Ann Arbor, MI 48160, United States of America.
| | - Paris Wheeler
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 235 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
| | - Candice Hargons
- University of Kentucky, Department of Educational, School, and Counseling Psychology, 239 Dickey Hall, 251 Scott Street, Lexington, KY 40503, United States of America.
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Alsheikh MY. Post-Acute Withdrawal Syndrome: The Major Cause of Relapse among Psychoactive Substances Addicted Users. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/ioicfujpnm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Xuan Z, Choi J, Lobrutto L, Cunningham T, Castedo de Martell S, Cance J, Silverstein M, Yule AM, Botticelli M, Holleran Steiker L. Support Services for Young Adults With Substance Use Disorders. Pediatrics 2021; 147:S220-S228. [PMID: 33386325 PMCID: PMC9034746 DOI: 10.1542/peds.2020-023523e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
In summarizing the proceedings of a longitudinal meeting of experts in substance use disorders (SUDs) among young adults, this special article reviews principles of care concerning recovery support services for this population. Young adults in recovery from SUDs can benefit from a variety of support services throughout the process of recovery. These services take place in both traditional clinical settings and settings outside the health system, and they can be delivered by a wide variety of nonprofessional and paraprofessional individuals. In this article, we communicate fundamental points related to guidance, evidence, and clinical considerations about 3 basic principles for recovery support services: (1) given their developmental needs, young adults affected by SUDs should have access to a wide variety of recovery support services regardless of the levels of care they need, which could range from early intervention services to medically managed intensive inpatient services; (2) the workforce for addiction services for young adults benefits from the inclusion of individuals with lived experience in addiction; and (3) recovery support services should be integrated to promote recovery most effectively and provide the strongest possible social support.
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Affiliation(s)
- Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts;
| | - Jasmin Choi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Lara Lobrutto
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Tiffany Cunningham
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas
| | | | - Jessica Cance
- RTI International, Research Triangle Park, North Carolina; Departments of
| | - Michael Silverstein
- Pediatrics and
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, Massachusetts
| | - Amy M Yule
- Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts; and
| | - Michael Botticelli
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, Massachusetts
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Kikuchi A, Soshi T, Kono T, Koyama M, Fujii C. Validity of Short-Term Assessment of Risk and Treatability in the Japanese Forensic Probation Service. Front Psychiatry 2021; 12:645927. [PMID: 34025475 PMCID: PMC8131669 DOI: 10.3389/fpsyt.2021.645927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/06/2021] [Indexed: 01/04/2023] Open
Abstract
This study aimed to evaluate the predictive validity and reliability of the Short-Term Assessment of Risk and Treatability (START) in the context of the Japanese forensic probation service. START is a structured professional judgement guide for risk domains concerning negative behaviors such as violence, self-harm, suicide, substance abuse, unauthorized leave, victimization, and self-neglect. In this study, rehabilitation coordinators evaluated community-dwelling patients who were treated under the Medical Treatment and Supervision Act at baseline and followed-up for 6 months. The results revealed that START vulnerability scores significantly predicted self-harm, suicide, physical aggression, substance abuse, and self-neglect. START strength scores predicted physical violence and unauthorized leave. Specific risk estimates predicted physical violence and self-neglect. Risk judgement for future substance use may require adjustments for cultural differences, because of the lower prevalence in Japan. These results suggest that START offers a feasible and valid tool that allows clinicians to plan treatment and promote recovery of forensic patients in Japan.
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Affiliation(s)
- Akiko Kikuchi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takahiro Soshi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Toshiaki Kono
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mayuko Koyama
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Chiyo Fujii
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Improving retention across the OUD service cascade upon reentry from jail using Recovery Management Checkups-Adaptive (RMC-A) experiment. J Subst Abuse Treat 2020; 128:108245. [PMID: 33461829 DOI: 10.1016/j.jsat.2020.108245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
Incarcerated individuals with opioid use disorders (OUD) should be linked to community-based treatment with medications for opioid use disorder (MOUD) upon their release, as well as to services that provide support for their ongoing recovery. The RMC-A experiment will test an adapted version of the evidence-based Recovery Management Checkups (RMC), which provides treatment linkage, support for retention, and re-linkage as indicated at quarterly checkups. A total of 750 male and female individuals will be recruited from 5 county jails in Illinois and randomly assigned to 1 of 3 groups at release from jail: a) Monitoring and Treatment Referral (MTR); b) quarterly RMC (RMC-Q); or c) RMC-A, which adjusts the frequency and intensity of checkups based on the individual's assessed need for treatment at each checkup. Measurement includes quarterly research follow-up assessments for 2 years, urine tests, and records checks (treatment, mortality, recidivism). The study aims to evaluate: (1) the direct effects of RMC-Q/RMC-A on MOUD treatment initiation, engagement, retention, and re-linkage; (2) the indirect effects of RMC-Q/RMC-A (via months of MOUD) on public health outcomes (days of opioid use, OUD symptoms, quality of life, cost of health care utilization); (3) the indirect effects of RMC-Q/RMC-A (via months of MOUD and public health outcomes) on public safety outcomes (illegal activity, re-arrest, re-incarceration, cost of crime); and (4) the incremental costs and cost-effectiveness of MTR vs. RMC-Q vs. RMC-A on public health and public safety outcomes. This experiment will determine whether the adapted RMC model improves the overall effectiveness and cost-effectiveness of the fixed quarterly RMC.
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