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Abrantes AM, Browne J, Stein MD, Anderson B, Iacoi S, Barter S, Shah Z, Read J, Battle C. A lifestyle physical activity intervention for women in alcohol treatment: A pilot randomized controlled trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209406. [PMID: 38759733 DOI: 10.1016/j.josat.2024.209406] [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: 04/28/2023] [Revised: 03/20/2024] [Accepted: 05/14/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Compared to men, women with alcohol use disorder (AUD) are more likely to drink to manage stress and negative affect. Given women's risk for poor drinking outcomes, it is critical to develop and test interventions that target these affective factors. Physical activity improves negative affect and has emerged as a promising adjunct to AUD treatment and, thus, may be especially valuable for women. METHODS Fifty women with AUD (49.9 ± 12.0 years of age) participated in either a 12-week telephone-delivered lifestyle physical activity plus Fitbit (LPA + Fitbit) or a health education contact (HEC) control intervention following a partial hospital addictions treatment program. The study examined changes in drinking behaviors, mental health outcomes, and physical activity engagement post-intervention using both conventional test statistics and standard effect sizes. RESULTS Higher rates of continuous abstinence during the 12-week period were observed in the LPA + Fitbit condition (55.6 %) than in the HEC condition (33.6 %); odds ratio = 2.97. However, among women who drank any alcohol during the 12-weeks, slightly higher rates of heavy drinking and drinks/day were observed among women in the LPA + Fitbit condition. Significant differences for improved mental health outcomes (including depression, anxiety, negative affect, positive affect, perceived stress, and behavioral activation) and increased self-reported physical activity were consistently observed among participants in the LPA + Fitbit condition, relative to HEC. CONCLUSIONS The LPA + Fitbit program had a positive impact on alcohol abstinence, mental health, and physical activity in adult women receiving treatment for AUD. Future research should continue to investigate the optimal implementation strategies, duration, and intensity of LPA interventions in the context of a fully-powered RCT.
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Affiliation(s)
- Ana M Abrantes
- Butler Hospital, Providence, RI, United States of America; Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Julia Browne
- Alpert Medical School of Brown University, Providence, RI, United States of America; Research Service, VA Providence Healthcare System, Providence, RI, United States of America
| | - Michael D Stein
- Butler Hospital, Providence, RI, United States of America; Boston University School of Public Health, Boston, MA, United States of America
| | | | - Sydney Iacoi
- Butler Hospital, Providence, RI, United States of America
| | - Sarah Barter
- Butler Hospital, Providence, RI, United States of America
| | - Zainab Shah
- Butler Hospital, Providence, RI, United States of America
| | - Jennifer Read
- University of Buffalo, Buffalo, NY, United States of America
| | - Cynthia Battle
- Butler Hospital, Providence, RI, United States of America; Alpert Medical School of Brown University, Providence, RI, United States of America; Women & Infants' Hospital of Rhode Island, Providence, RI, United States of America
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Chapman SA, Fraimow-Wong L, Phoenix BJ, Tierney M, Spetz J. Perspectives on APRN prescribing of medications for opioid use disorder: Key barriers remain. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209215. [PMID: 37979946 PMCID: PMC11092094 DOI: 10.1016/j.josat.2023.209215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/22/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Deaths from drug overdoses are rising dramatically in the United States. Treatment for opioid use disorders may include behavioral treatments as well as medications for opioid use disorders (MOUD). Buprenorphine can be prescribed by physicians, nurse practitioners (NPs), other advanced practice registered nurses (APRNs), and physician assistants (PAs) and required a training and a federal waiver until recently. The number of NP MOUD prescribers grew steadily over the past decade, but research has identified state-level scope of practice regulations as a barrier to NP MOUD prescribing. This article explores the contributions of, and remaining barriers faced by NP and other APRN MOUD prescribers. We describe qualitative findings from a study of NPs and other key stakeholders involved in MOUD treatment in four states with two differing levels of regulatory structure. METHODS In this qualitative study, we conducted site visits and semi-structured interviews with NPs and other APRNs, physicians, clinic managers, and regulators in four states including New Mexico and West Virginia (full practice authority for NPs), and Ohio and Michigan (which require physician supervision). Interview notes were entered into a qualitative software package and coded and reviewed by two members of the research team. Data were grouped into key themes. RESULTS A total of 76 participants participated in individual or small group interviews in the four states. We found key themes and several subthemes that describe NP practice in MOUD. Participants described key contributions of NP engagement in MOUD, including increasing access, serving rural areas, the unique role of psychiatric NPs, and the value of the nursing model of care in working with people with substance use disorders (SUD). Participants also identified barriers including scope of practice regulations, other regulatory barriers, stigma, and lack of supportive services to address psychosocial needs. CONCLUSIONS The waiver requirements were eliminated at the end of 2022 in federal budget legislation. Other barriers for NP and other APRN prescribers remain and should be addressed in practice, and in state and federal regulations. Research needs to explore the impact of the waiver elimination on MOUD prescribing and access to services.
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Affiliation(s)
- Susan A Chapman
- University of California San Francisco School of Nursing, Department of Social and Behavioral Sciences, 490 Illinois Street, 12th Floor, San Francisco, CA 94143, United States of America.
| | - Leah Fraimow-Wong
- UCSF School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, United States of America.
| | - Bethany J Phoenix
- University of California San Francisco School of Nursing, Department of Community Health Systems, 2 Koret Way, 5th Floor, San Francisco, CA 94143-0608, United States of America.
| | - Matthew Tierney
- University of California San Francisco School of Nursing, Department of Community Health Systems, 2 Koret Way, 5th Floor, San Francisco, CA 94143-0608, United States of America.
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA 94158, United States of America.
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Traccis F, Minozzi S, Trogu E, Vacca R, Vecchi S, Pani PP, Agabio R. Disulfiram for the treatment of cocaine dependence. Cochrane Database Syst Rev 2024; 1:CD007024. [PMID: 38180268 PMCID: PMC10767770 DOI: 10.1002/14651858.cd007024.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Cocaine is a psychostimulant used by approximately 0.4% of the general population worldwide. Cocaine dependence is a chronic mental disorder characterised by the inability to control cocaine use and a host of severe medical and psychosocial complications. There is current no approved pharmacological treatment for cocaine dependence. Some researchers have proposed disulfiram, a medication approved to treat alcohol use disorder. This is an update of a Cochrane review first published in 2010. OBJECTIVES To evaluate the efficacy and safety of disulfiram for the treatment of cocaine dependence. SEARCH METHODS We updated our searches of the following databases to August 2022: the Cochrane Drugs and Alcohol Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and PsycINFO. We also searched for ongoing and unpublished studies via two trials registries. We handsearched the references of topic-related systematic reviews and included studies. The searches had no language restrictions. SELECTION CRITERIA We included randomised controlled trials that evaluated disulfiram alone or associated with psychosocial interventions versus placebo, no intervention, other pharmacological interventions, or any psychosocial intervention for the treatment of cocaine dependence. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Thirteen studies (1191 participants) met our inclusion criteria. Disulfiram versus placebo or no treatment Disulfiram compared to placebo may increase the number of people who are abstinent at the end of treatment (point abstinence; risk ratio (RR) 1.58, 95% confidence interval (CI) 1.05 to 2.36; 3 datasets, 142 participants; low-certainty evidence). However, compared to placebo or no pharmacological treatment, disulfiram may have little or no effect on frequency of cocaine use (standardised mean difference (SMD) -0.11 standard deviations (SDs), 95% CI -0.39 to 0.17; 13 datasets, 818 participants), amount of cocaine use (SMD -0.00 SDs, 95% CI -0.30 to 0.30; 7 datasets, 376 participants), continuous abstinence (RR 1.23, 95% CI 0.80 to 1.91; 6 datasets, 386 participants), and dropout for any reason (RR 1.20, 95% CI 0.92 to 1.55; 14 datasets, 841 participants). The certainty of the evidence was low for all these outcomes. We are unsure about the effects of disulfiram versus placebo on dropout due to adverse events (RR 12.97, 95% CI 0.77 to 218.37; 1 study, 67 participants) and on the occurrence of adverse events (RR 3.00, 95% CI 0.35 to 25.98), because the certainty of the evidence was very low for these outcomes. Disulfiram versus naltrexone Disulfiram compared with naltrexone may reduce the frequency of cocaine use (mean difference (MD) -1.90 days, 95% CI -3.37 to -0.43; 2 datasets, 123 participants; low-certainty evidence) and may have little or no effect on amount of cocaine use (SMD 0.12 SDs, 95% CI -0.27 to 0.51, 2 datasets, 123 participants; low-certainty evidence). We are unsure about the effect of disulfiram versus naltrexone on dropout for any reason (RR 0.86, 95% CI 0.56 to 1.32, 3 datasets, 131 participants) and dropout due to adverse events (RR 0.50, 95% CI 0.07 to 3.55; 1 dataset, 8 participants), because the certainty of the evidence was very low for these outcomes. AUTHORS' CONCLUSIONS Our results show that disulfiram compared to placebo may increase point abstinence. However, disulfiram compared to placebo or no pharmacological treatment may have little or no effect on frequency of cocaine use, amount of cocaine use, continued abstinence, and dropout for any reason. We are unsure if disulfiram has any adverse effects in this population. Caution is required when transferring our results to clinical practice.
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Affiliation(s)
- Francesco Traccis
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Emanuela Trogu
- Department of Mental Health, Psychiatric Diagnosis and Treatment Service, Local Social Health Agency, Cagliari, Italy
| | - Rosangela Vacca
- SC Clinical Governance and PDTA, ARES Sardegna, Sassari, Italy
| | - Simona Vecchi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Pier Paolo Pani
- Social Health Services, Sardinia Protection Health Trust, Cagliari, Italy
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neurosciences and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
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Scheidell JD, Pitre M, Andraka-Christou B. Racial and ethnic inequities in substance use treatment among women with opioid use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:106-116. [PMID: 38295349 DOI: 10.1080/00952990.2023.2291748] [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: 07/20/2023] [Accepted: 12/02/2023] [Indexed: 02/02/2024]
Abstract
Background: Research describes inequities in substance use treatment, but few studies focus specifically on racial and ethnic disparities in a range of aspects of substance use treatment among women with opioid use disorder (OUD).Objective: To examine whether substance use treatment (i.e. receipt, sources, barriers) differs by race and ethnicity among women with opioid use disorder (OUD) and to identify factors associated with treatment gap (i.e. needing treatment but not receiving it).Methods: We performed cross-sectional analyses using National Survey on Drug Use and Health 2015-2019 data, restricted to non-Hispanic Black, non-Hispanic White, and Hispanic women with past-year OUD (unweighted n = 1089). We estimated the prevalence of aspects of treatment among racial and ethnic groups, and used modified Poisson regression to estimate correlates of reported treatment gap.Results: Approximately 68% of White versus 87% of Black and 81% of Hispanic women with OUD had a treatment gap (p-value 0.0034). Commonly reported barriers to treatment included prioritization, affordability, and stigma. Older age was associated with lower prevalence of treatment gap among all women [prevalence ratio (PR) = 0.83, and 95% confidence interval (CI): 0.76, 0.92], while criminal legal involvement and healthcare coverage was associated with a lower prevalence of treatment gap among Hispanic and White women only (past year arrest: Hispanic women PR = 0.38, 95% CI: 0.17, 0.86; White women PR = 0.62, 95% CI: 0.47, 0.82).Conclusions: Receipt of treatment is low among women with OUD, especially Black and Hispanic women. Intersectional intervention approaches are needed to increase access and reduce inequities.
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Affiliation(s)
- Joy D Scheidell
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, United States
| | - Maya Pitre
- Department of Social Work, College of Health Professions and Sciences, University of Central Florida, Orlando, United States
| | - Barbara Andraka-Christou
- School of Global Health Management and Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, United States
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Ward S, Autaubo J, Waters P, Garrett E, Batioja K, Anderson R, Furr-Holden D, Vassar M. A scoping review of health inequities in alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:27-41. [PMID: 38295346 DOI: 10.1080/00952990.2023.2296860] [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: 01/15/2023] [Accepted: 12/10/2023] [Indexed: 02/02/2024]
Abstract
Background: Alcohol Use Disorder (AUD) poses a significant health burden on individuals. The burden occurs more frequently in the medically underserved, as well as racial and sexual minority populations. Ameliorating health inequities is vital to improving patient-centered care.Objectives: The objective of this scoping review is to chart the existing evidence on health inequities related to AUD and identify existing knowledge gaps to guide future equity-centered research.Methods: We performed a literature search using the Ovid (Embase) and MEDLINE (PubMed) databases for articles on AUD that were published in the 5-year period spanning from 2017 to 2021 and written in English. The frequencies of each health inequity examined were analyzed, and findings from each included study were summarized.Results: Our sample consisted of 55 studies for analysis. The most common inequity examined was by race/ethnicity followed by sex or gender. The least reported inequities examined were rural under-resourced areas and occupational status. Our findings indicate that significant research gaps exist in education, rural under-resourced populations, and LGBTQ+ communities with AUD.Conclusions: This scoping review highlights the gaps in research on inequities in AUD. To bridge the current gaps, we recommend research on the following: 1) triage screening tools and the use of telemedicine for rural, under-resourced populations; 2) interventions to increase treatment engagement and retention for women; and 3) community-based participatory methodologies for the LGBTQ+ communities.
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Affiliation(s)
- Shaelyn Ward
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Josh Autaubo
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Philo Waters
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Elizabeth Garrett
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Kelsi Batioja
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Reece Anderson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Debra Furr-Holden
- School of Global Public Health, New York University, New York, NY, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Staton M, Tillson M, Levi MM, Webster M, Oser C, Leukefeld C. Screening Incarcerated Women for Opioid Use Disorder. JOURNAL OF DRUG ISSUES 2024; 54:57-73. [PMID: 38046434 PMCID: PMC10688603 DOI: 10.1177/00220426231151595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The overall aim of the present study is to examine the utility of the DSM OUD Checklist and the NM-ASSIST screening tools to identify symptoms consistent with OUD among incarcerated women in county jails. This study contributes to the existing literature because research on screening and assessment approaches for incarcerated women has been limited. The focus of the current study is to describe the screening procedures and study recruitment for a larger parent study focused on increasing treatment linkages. Study findings indicate a positive correlation between indicators of OUD using the two screening tools, as well as a high degree of correlation between street opioid misuse and other high-risk drug indicators (overdose and injection practices). These findings underscore the importance of outreach, screening, and intervention in real-world settings, including jails, in order to increase access to OUD treatment among this vulnerable sample of women.
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Affiliation(s)
- Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Martha Tillson
- Department of Sociology, College of Arts & Sciences, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Mary M. Levi
- Department of Psychology, College of Arts & Sciences, University of Kentucky, Lexington, KY, USA
| | - Matthew Webster
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Carrie Oser
- Faculty Affiliate, Center for Health Equity Transformation, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Carl Leukefeld
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
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Bauer AG, Bellot J, Bazan C, Gilmore A, Kideys K, Cameron A. Cultural considerations for substance use and substance use disorders among Black men. Bull Menninger Clin 2024; 88:108-127. [PMID: 38836848 DOI: 10.1521/bumc.2024.88.2.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
There are complex cultural considerations for understanding, assessing, and treating substance use disorders (SUD) among Black men, from the initiation of substance use through SUD-related outcomes. This narrative review provides insight into some of these factors, including the individual, interpersonal, and community-level risk and protective factors (e.g., family and social roles, religiosity, racism and discrimination, exposure to trauma and adversity) underlying relative risk for substance use and disparities in SUD-related outcomes. This article also highlights the ways that public attitudes and policies related to substance use have contributed to ongoing inequities in SUD treatment access for Black men. Recommendations for clinical research and practice include increasing focus on measurement equivalence, creating pathways for access to community-based and specialty treatment, and providing services that are culturally affirming, relevant, and appropriate. Comprehensive efforts are needed to reduce SUD-related inequities and promote positive well-being among Black men and their communities.
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Affiliation(s)
- Alexandria G Bauer
- Center of Alcohol & Substance Use Studies and the Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
| | - Jahnayah Bellot
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
| | - Carolyn Bazan
- School of Health Professions, Rutgers University, Piscataway, New Jersey
| | - Ayanna Gilmore
- New York State Psychiatric Institute, New York, New York
| | - Kaan Kideys
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, New Jersey
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Keyser-Marcus L, Ramey T, Bjork JM, Martin CE, Sabo R, Moeller FG. Initial Validation of a Behavioral Phenotyping Model for Substance Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:14. [PMID: 38276802 PMCID: PMC10815773 DOI: 10.3390/ijerph21010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024]
Abstract
Standard nosological systems, such as DSM-5 or ICD-10, are relied upon as the diagnostic basis when developing treatments for individuals with substance use disorder (SUD). Unfortunately, the vast heterogeneity of individuals within a given SUD diagnosis results in a variable treatment response and/or difficulties ascertaining the efficacy signal in clinical trials of drug development. Emerging precision medicine methods focusing on targeted treatments based on phenotypic subtypes rather than diagnosis are being explored as alternatives. The goal of the present study was to provide initial validation of emergent subtypes identified by an addiction-focused phenotyping battery. Secondary data collected as part of a feasibility study of the NIDA phenotyping battery were utilized. Participants completed self-report measures and behavioral tasks across six neurofunctional domains. Exploratory and confirmatory factor analysis (EFA/CFA) were conducted. A three-factor model consisting of negative emotionality, attention/concentration, and interoception and mindfulness, as well as a four-factor model adding a second negative emotion domain, emerged from the EFA as candidate models. The CFA of these models did not result in a good fit, possibly resulting from small sample sizes that hindered statistical power.
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Affiliation(s)
- Lori Keyser-Marcus
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Tatiana Ramey
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse (NIDA), Gaithersburg, MD 20877, USA
| | - James M. Bjork
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA;
| | - Roy Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23219, USA;
| | - F. Gerard Moeller
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
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Parlier-Ahmad AB, Kelpin S, Martin CE, Svikis DS. Baseline Characteristics and Postdischarge Outcomes by Medication for Opioid Use Disorder Status Among Women with Polysubstance Use in Residential Treatment. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:617-626. [PMID: 38145229 PMCID: PMC10739697 DOI: 10.1089/whr.2023.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/26/2023]
Abstract
Background Within residential treatment, medication for opioid use disorder (MOUD) is rarely offered, so little is known about group differences by MOUD status. This study characterizes samples of women receiving and not receiving MOUD and explores postdischarge outcomes. Methods This is a secondary exploratory analysis of a residential clinical trial comparing women receiving treatment as usual (TAU) with those who also received computer-based training for cognitive behavioral therapy (CBT4CBT). Participants were N = 41 adult women with substance use disorder (SUD) who self-reported lifetime polysubstance use. Because 59.0% were prescribed MOUD (MOUD n = 24, no MOUD n = 17), baseline variables were compared by MOUD status; outcomes at 12 weeks postdischarge were compared by MOUD status and treatment condition using chi square and Mann-Whitney U tests. Results Participants were middle-aged (41.7 ± 11.6 years) and non-Latinx Black (80.4%). Most used substances in the No MOUD group were alcohol, cocaine, and cannabis, and in the MOUD group, most used substances were opioids, cannabis, and cocaine. Women in the MOUD group tended to have more severe SUD. Postdischarge substance use recurrence rates were twice as high in the MOUD group than in the No MOUD group. Among the women in the No MOUD group, those in the CBT4CBT condition increased the number of coping strategies twice as much as those receiving TAU. Conclusion Postdischarge substance use recurrence differed by MOUD status. CBT4CBT may be a helpful adjunct to personalized residential SUD treatment. The parent study is registered at [www.clinicaltrials.gov (ClinicalTrials.gov identifier: NCT03678051)].
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Affiliation(s)
- Anna Beth Parlier-Ahmad
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sydney Kelpin
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dace S. Svikis
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
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Levine EA, Sugarman DE, Rockas M, McHugh RK, Jordan C, Greenfield SF. Alcohol Treatment Access and Engagement Among Women in the USA: a Targeted Review of the Literature 2012-2022. CURRENT ADDICTION REPORTS 2023; 10:638-648. [PMID: 38505370 PMCID: PMC10948108 DOI: 10.1007/s40429-023-00515-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 03/21/2024]
Abstract
Purpose of Review The purpose of this review is to examine recent literature (2012-2022) on alcohol treatment access and engagement in women in the U.S. and propose future directions for research and clinical practice. Recent Findings A targeted literature review resulted in 27 studies encompassing screening and brief intervention (SBIRT), treatment utilization, treatment engagement, and barriers to treatment. Recent literature demonstrates overall low rates of screening and brief interventions and treatment utilization in the population with women less likely to be screened and utilize alcohol treatment. The magnitude of these gender differences varies with race/ethnicity. Extensive barriers to care include provider knowledge, structural barriers, and attitudinal barriers and these vary with service setting, gender, and race/ethnicity. Summary There is an increasing prevalence of alcohol use and Alcohol Use Disorder (AUD) in women with low rates of screening, brief treatment, treatment, and engagement which have resulted from extensive barriers to care. Possible areas of further inquiry include the impact of race/ethnicity on gender differences, improving provider and system level policies to promote SBIRT and treatment engagement and utilization, further developing digital interventions, and implementation research to investigate factors associated with optimizing effectiveness of gender-responsive and culturally tailored interventions that address the unique needs of women.
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Affiliation(s)
| | | | - Mary Rockas
- McLean Hospital
- Department of Psychiatry, Harvard Medical School
| | | | - Chloe Jordan
- McLean Hospital
- Department of Psychiatry, Harvard Medical School
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Gray J, Santos-Lozada AR, Hard G, Apsley H, O’Sullivan D, Jones AA. Serious Psychological Distress, Substance Use Disorders, and Social Issues Among Men and Women in the United States During the COVID-19 Pandemic. Am J Health Promot 2023; 37:933-939. [PMID: 37401052 PMCID: PMC10333561 DOI: 10.1177/08901171231188187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
PURPOSE This study assesses the association between SUD, economic hardship, gender, and related risk and protective factors on serious psychological distress (SPD) during the COVID-19 pandemic. DESIGN Quantitative cross-sectional design. SETTING National Survey on Drug Use and Health (NSDUH). SAMPLE Data were from the NSDUH (2020) N = 25,746, representing 238,677,123 US adults, who identified as 18 or older and either male or female. MEASURES SPD measured as scoring a 13 or more on the Kessler (K6) distress scale. SUDs were determined using DSM5 criteria. Sociodemographic and socioeconomic variables included in analyses. ANALYSIS Logistic regressions evaluated the association between gender, protective, and risk factors on SPD. RESULTS After controlling for sociodemographic and related factors of SPD, having a SUD was the strongest correlate of SPD. Other significant correlates of SPD included female gender and an income level at or below the federal poverty threshold. Gender stratified regressions illustrated that religiosity, self-identifying as Black, and high levels of education were protective against SPD for women but not men. Poverty level was more associated with SPD for women than men. CONCLUSION In the United States, individuals with SUDs were nearly four times more likely to report SPD than those without SUDs, controlling for economic hardship and markers of social support during 2020. Effective social interventions to reduce SPD among individuals with SUDs are needed.
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Affiliation(s)
- Joy Gray
- Department of Educational Psychology, Counseling, and Special Education College of Education, The Pennsylvania State University, University Park, PA, USA
| | - Alexis R. Santos-Lozada
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Greg Hard
- Simches Division of Child and Adolescent Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Hannah Apsley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Deirdre O’Sullivan
- Department of Educational Psychology, Counseling, and Special Education College of Education, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, The Pennsylvania State University, University Park, PA, USA
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Consortium on Substance Use and Addiction, The Pennsylvania State University, University Park, PA, USA
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12
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Parlier‐Ahmad AB, Eglovitch M, Legge C, Keyser‐Marcus LA, Bjork JM, Adams A, Ramey T, Moeller FG, Martin CE. Development and clinical feasibility study of a brief version of an addiction-focused phenotyping battery in females receiving buprenorphine for opioid use disorder. Brain Behav 2023; 13:e3128. [PMID: 37367725 PMCID: PMC10454248 DOI: 10.1002/brb3.3128] [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: 03/14/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION We aimed to streamline the NIDA Phenotyping Assessment Battery (PhAB), a package of self-report scales and neurobehavioral tasks used in substance use disorder (SUD) clinical trials, for clinical administration ease. Tailoring the PhAB to shorten administration time for a treatment setting is critical to expanding its acceptability in SUD clinical trials. This study's primary objectives were to develop a brief version of PhAB (PhAB-B) and assess its operational feasibility and acceptability in a female clinical treatment sample. METHODS Assessments of the original PhAB were evaluated along several criteria to identify a subset for the PhAB-B. Non-pregnant females (N=55) between ages 18-65, stabilized on buprenorphine for opioid use disorder (OUD) at an outpatient addiction clinic, completed this abbreviated battery remotely or after a provider visit in clinic. Participant satisfaction questions were administered. REDCap recorded the time to complete PhAB-B measures. RESULTS The PhAB-B included 11 measures that probed reward, cognition, negative emotionality, interoception, metacognition, and sleep. Participants who completed the PhAB-B (N =55) were 36.1 ± 8.9 years of age, White (54.5%), Black (34.5%), and non-Latinx (96.0%). Most participants completed the PhAB-B remotely (n = 42, 76.4%). Some participants completed it in-person (n = 13, 23.6%). PhAB-B mean completion time was 23.0 ± 12.0 min. Participant experiences were positive, and 96% of whom reported that they would participate in the study again. CONCLUSION Our findings support the clinical feasibility and acceptability of the PhAB-B among a female opioid use disorder outpatient addiction treatment sample. Future studies should assess the PhAB-B psychometric properties among broader treatment samples.
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Affiliation(s)
| | - Michelle Eglovitch
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Catherine Legge
- School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Lori A. Keyser‐Marcus
- Institute for Drug and Alcohol StudiesVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - James M. Bjork
- Institute for Drug and Alcohol StudiesVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Amanda Adams
- Institute for Drug and Alcohol StudiesVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Tanya Ramey
- National Institute of Drug AbuseBethesdaMarylandUSA
| | | | - Caitlin E. Martin
- Institute for Drug and Alcohol StudiesVirginia Commonwealth UniversityRichmondVirginiaUSA
- Department of Obstetrics and GynecologySchool of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
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13
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Yoade B, Akinbode O, Olatunji O, Popoola O, Busari O, Odenigbo N, Kogan I, Nkemjika S. Alcohol Use Disorder (AUD) in New Jersey (NJ): Disparity in Treatment. Cureus 2023; 15:e43286. [PMID: 37692715 PMCID: PMC10492633 DOI: 10.7759/cureus.43286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Alcohol use disorder (AUD) continues to be a threat to public health due to the associated morbidity, mortality, and social and economic impacts. AUD accounts for greater than 85,000 deaths annually in the United States and greater than 1500 deaths annually in New Jersey (NJ). Despite these associated burdens, the treatment of AUD remains unequal among the population, and it is important to identify the factors influencing the disparity in defined population groups such as NJ to drive the appropriate intervention. Data were retrieved from the 2018 Treatment Episode Data Set-Discharges (TEDS-D) of the United States Substance Abuse and Mental Health Services Administration (SAMHSA). Logistic regression analysis was used to predict the odds of receiving treatment based on socioeconomic factors and the type of treatment received. Compared to Asian or Pacific Islanders in NJ, the American Indian [odds ratio, OR=2.12, 95% confidence interval, CI: 1.95-2.31] has the greatest odds of receiving treatment for AUD, followed by the Black or African American [OR=1.70, 95% CI: 1.65-1.75], the Alaska Native [OR=1.67, 95% CI: 1.42-1.96], and then the White [OR=1.31, 95% CI: 1.12-1.52]. Those who are retired or on disability [OR=0.88, 95% CI: 0.82-0.94] have lower odds of receiving treatment than those on salary or wages. Those with AUD in NJ have a lower odd of receiving detoxification treatment in a 24-h hospital inpatient setting [OR=0.88, 95% CI 0.82-0.95] and a higher odd of receiving detoxification treatment in a 24-h service, free-standing residential setting when compared to the treatment received in a rehabilitation/hospital (other than detoxification) setting. This study shows that disparity exists in relation to the type of treatment received and the setting of treatment for AUD in NJ in addition to disparity based on the sociodemographic factors.
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Affiliation(s)
| | | | - Olubusola Olatunji
- College of Health Sciences & Human Services, North Kentucky University, Kentucky, USA
| | - Olufemi Popoola
- Neiswanger Institute of Bioethics and Healthcare Leadership, Loyola University, Illinois, USA
| | - Oluwatoyin Busari
- Psychiatry, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, USA
| | - Nkolika Odenigbo
- Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
| | - Irina Kogan
- Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
| | - Stanley Nkemjika
- Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
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14
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Martin CE, Patel H, Dzierewski JM, Moeller FG, Bierut LJ, Grucza RA, Xu KY. Benzodiazepine, Z-drug, and sleep medication prescriptions in male and female people with opioid use disorder on buprenorphine and comorbid insomnia: an analysis of multistate insurance claims. Sleep 2023; 46:zsad083. [PMID: 36970994 PMCID: PMC10262036 DOI: 10.1093/sleep/zsad083] [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: 12/02/2022] [Revised: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
STUDY OBJECTIVES In adult populations, women are more likely than men to be prescribed benzodiazepines. However, such disparities have not been investigated in people with opioid use disorder (OUD) and insomnia receiving buprenorphine, a population with particularly high sedative/hypnotic receipt. This retrospective cohort study used administrative claims data from Merative MarketScan Commercial and MultiState Medicaid Databases (2006-2016) to investigate sex differences in the receipt of insomnia medication prescriptions among patients in OUD treatment with buprenorphine. METHODS We included people aged 12-64 years with diagnoses of insomnia and OUD-initiating buprenorphine during the study timeframe. The predictor variable was sex (female versus male). The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g. hydroxyzine, trazodone, and mirtazapine). Associations between sex and benzodiazepine, Z-drug, and other insomnia medication prescription receipt were estimated using Poisson regression models. RESULTS Our sample included 9510 individuals (female n = 4637; male n = 4873) initiating buprenorphine for OUD who also had insomnia, of whom 6569 (69.1%) received benzodiazepines, 3891 (40.9%) Z-drugs, and 8441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR = 1.17 [1.11-1.23]), Z-drugs (RR = 1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR = 1.07, [1.02-1.12]). CONCLUSIONS Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment with buprenorphine, with sex-based disparities indicating a higher prescribing impact among female than male OUD treatment patients.
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Affiliation(s)
- Caitlin E Martin
- Department of Obstetrics and Gynecology and VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Hetal Patel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - F. Gerard Moeller
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J Siteman Cancer Center, Barnes Jewish Hospital, St. Louis, MO, USA
| | - Richard A Grucza
- Departments of Family and Community Medicine and Health and Outcomes Research, St. Louis University, St. Louis, MO, USA
| | - Kevin Y Xu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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15
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Crawford CA, Taylor JA, Park GI, Rios JW, Bunch J, Greenwood CJ, Lopez Sanchez DY, Gonzales DJ. Effects of neonatal fentanyl on late adolescent opioid-mediated behavior. Front Neurosci 2023; 17:1094241. [PMID: 36866335 PMCID: PMC9971583 DOI: 10.3389/fnins.2023.1094241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Because of the steady increase in the use of synthetic opioids in women of childbearing age, a large number of children are at risk of exposure to these drugs prenatally or postnatally through breast milk. While there is older literature looking at the effects of morphine and heroin, there are relatively few studies looking at the long-term effects of high-potency synthetic opioid compounds like fentanyl. Thus, in the present study, we assessed whether brief exposure to fentanyl in male and female rat pups during a period roughly equivalent to the third trimester of CNS development altered adolescent oral fentanyl self-administration and opioid-mediated thermal antinociception. Methods We treated the rats with fentanyl (0, 10, or 100 μg/kg sc) from postnatal day (PD) 4 to PD 9. The fentanyl was administered daily in two injections given 6 h apart. After the last injection on PD 9, the rat pups were left alone until either PD 40 where they began fentanyl self-administration training or PD 60 where they were tested for morphine- (0, 1.25, 2.5, 5, or 10 mg/kg) or U50,488- (0, 2.5, 5, 10, or 20 mg/kg) induced thermal antinociception. Results In the self-administration study, we found that female rats had more active nose pokes than male rats when receiving a fentanyl reward but not sucrose alone solution. Early neonatal fentanyl exposure did not significantly alter fentanyl intake or nose-poke response. In contrast, early fentanyl exposure did alter thermal antinociception in both male and female rats. Specifically, fentanyl (10 μg/kg) pre-treatment increased baseline paw-lick latencies, and the higher dose of fentanyl (100 μg/kg) reduced morphine-induced paw-lick latencies. Fentanyl pre-treatment did not alter U50,488-mediated thermal antinociception. Conclusions Although our exposure model is not reflective of typical human fentanyl use during pregnancy, our study does illustrate that even brief exposure to fentanyl during early development can have long-lasting effects on mu-opioid-mediated behavior. Moreover, our data suggest that females may be more susceptible to fentanyl abuse than males.
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Affiliation(s)
| | - Jordan A. Taylor
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Ginny I. Park
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Jasmine W. Rios
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Joseph Bunch
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Constance J. Greenwood
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - David Y. Lopez Sanchez
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
| | - Diego J. Gonzales
- Department of Psychology, California State University, San Bernardino, San Bernardino, CA, United States
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16
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Maddox-Rooper TR, Sklioutouskaya-Lopez K, Sturgill T, Fresch C, Clements CW, Lamichhane R, Egleton R, Davies TH. Intake assessments of salivary cortisol, survey responses, and adverse childhood experiences are associated with recovery success in an abstinence-based treatment program for substance use disorders. Alcohol Clin Exp Res 2022; 46:1865-1874. [PMID: 36016476 DOI: 10.1111/acer.14913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/28/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Connecting patients to treatment for a substance use disorder (SUD) that satisfies their needs is often complicated by confounding factors. A reliable measurement of patients' underlying stress level may be helpful because it often reflects many of the same confounders as their SUD. Whereas cortisol levels reflect physiological responses to stress, patients' cortisol levels during recovery from an SUD may serve as biomarkers for stressors that result in poor treatment outcomes, including early discontinuation of treatment. However, further exploration of the relationship between patients' cortisol levels and their treatment outcomes is needed for this approach to be clinically useful. METHODS We enrolled participants from an abstinence-based, male-only, residential alcohol and drug recovery program to examine the relationship between salivary cortisol, stress exposure, ACEs, and treatment retention. RESULTS Participants who remained in the program <90 days had significantly higher initial cortisol levels than those who remained ≥90 days (0.62 ± 0.074 μg/dl vs. 0.36 ± 0.037 μg/dl). Kaplan-Meier curves differed significantly when we grouped participants according to whether their cortisol level was below or above the overall average of 0.49 ± 0.044 μg/dl, with the median numbers of days before discontinuing being 110 and 60, respectively. A Cox proportional hazards model indicated that elevated salivary cortisol (with increases in μg/dl), marital/relationship status, and adverse childhood experiences (ACEs) score correlated significantly with hazards of discontinuing the program (hazard ratios for the three factors were 3.49, 2.39, and 1.50, respectively). DISCUSSION Cortisol level may predict, at least partially, SUD treatment program retention regardless of individuals' numerous confounding factors or the substance used. If this approach is validated, it could enable providers to consider patients' cortisol levels at the time of admission to treatment to facilitate their retention in treatment and thereby enhance their recovery.
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Affiliation(s)
- Taylor R Maddox-Rooper
- Department of Family and Community Health, Joan C Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
| | - Kristiana Sklioutouskaya-Lopez
- Department of Family and Community Health, Joan C Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
| | | | - Caroline Fresch
- Department of Family and Community Health, Joan C Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
| | - Charles W Clements
- Department of Family and Community Health, Joan C Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
| | - Rajan Lamichhane
- Department of Clinical and Translational Sciences, Joan C Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
| | - Richard Egleton
- Department of Biological Sciences, Joan C Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
| | - Todd H Davies
- Department of Family and Community Health, Joan C Edwards School of Medicine at Marshall University, Huntington, West Virginia, USA
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17
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Efrati Y, Kolubinski DC, Marino C, Spada MM. Early Maladaptive Schemas are Associated with Adolescents’ Substance and Behavioral Addictions. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2022. [DOI: 10.1007/s10942-022-00478-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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18
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Parlier-Ahmad AB, Radic M, Svikis DS, Martin CE. Short communication: Relationship between social determinants and opioid use disorder treatment outcomes by gender. Drug Alcohol Depend 2022; 232:109337. [PMID: 35123364 PMCID: PMC8885974 DOI: 10.1016/j.drugalcdep.2022.109337] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Social determinants of health (SDoH) influence health outcomes differentially across gender. Gender differences in SDoH have been identified at baseline in opioid use disorder (OUD) treatment studies, but less is known about how SDoH and gender intersect with OUD treatment trajectories. This study aims to identify social correlates of OUD treatment outcomes from five key areas of social determinants separately for men and women receiving buprenorphine for OUD. METHODS This is a secondary data analysis of a cross-sectional survey with medical record review conducted with patients recruited from an office based opioid treatment clinic. Participants completed surveys between July-September 2019. A 6-month prospective medical record review was conducted to determine treatment retention, substance use recurrence, and buprenorphine continuation. Chi square, T-tests, and Mann Whitney U tested differences in social factors and OUD outcomes by gender. Gender-stratified multivariable logistic and negative binomial regressions assessed predictors of OUD outcomes. RESULTS Among study participants (n = 142), women were significantly younger (p < 0.001), more likely to live in a safe neighborhood (p = 0.046), and less likely to be employed (p = 0.005) or have substance use recurrence during the study period (p = 0.033) than men. For women, employment (AOR=0.19, p = 0.031) and education (AOR=0.08, p = 0.040) were negatively associated with treatment retention. For men, no social factors were associated with OUD outcomes. CONCLUSIONS SDoH may impact OUD treatment outcomes differently by gender. Addressing MOUD stigma and implementing patient-centered care strategies may facilitate OUD treatment continuation among employed women in recovery. Gender-related social factors should be considered in OUD treatment research.
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Affiliation(s)
| | - Maja Radic
- Virginia Commonwealth University School of Medicine, Virginia Commonwealth University
| | - Dace S. Svikis
- Department of Psychology, Virginia Commonwealth University
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology and Institute for Drug and Alcohol Studies, Virginia Commonwealth University
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