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Kershaw S, Sunderland M, Grager A, Birrell L, Deen H, Newton NC, Stapinski LA, Champion KE, Kay-Lambkin F, Teesson M, Chapman C. Perceived barriers to help-seeking for people who use crystal methamphetamine: Perspectives of people with lived experience, family members and health workers. Drug Alcohol Rev 2024. [PMID: 38965840 DOI: 10.1111/dar.13897] [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: 07/31/2023] [Revised: 05/16/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Barriers to help-seeking for illicit drug use cross psychosocial (e.g., knowledge of where to seek help, attitudinal beliefs like being afraid of what people will think) and structural (e.g., service availability) domains. Along with people who use illicit drugs, it is important to consider the perspectives of other key groups who are often involved in the help-seeking and recovery process. This study aimed to examine the perceived barriers to help-seeking for people who use crystal methamphetamine ('ice') among key groups (people who use crystal methamphetamine, families and friends, health workers) as well as the general community. METHODS A cross-sectional online survey open to all Australian residents (aged ≥18 years) was conducted November 2018-March 2019. Four key groups of interest were recruited to examine and compare perceived barriers to help-seeking for crystal methamphetamine use. RESULTS Participants (n = 2108) included: people who use/have used crystal methamphetamine (n = 564, 39%), health workers (n = 288, 26.8%), affected family/friends (n = 434, 13.7%) and general community (n = 822, 20.6%). People who used crystal methamphetamine demonstrated increased odds of reporting attitudinal (OR 1.35; 1.02-1.80) or structural (OR 1.89; 1.09-3.27) barriers, or a previous negative help-seeking experience (OR 2.27; 1.41-3.66) compared to knowledge barriers. Health workers demonstrated decreased odds of reporting attitudinal compared to knowledge barriers (OR 0.69; 0.50-0.95). DISCUSSION AND CONCLUSIONS Perceived barriers to seeking help for crystal methamphetamine use differed among key groups involved in treatment and recovery. Acknowledging and addressing the mismatches between key groups, through targeted interventions may better support people to seek help for crystal methamphetamine use.
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Affiliation(s)
- Steph Kershaw
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Anna Grager
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Louise Birrell
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Hannah Deen
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Lexine A Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katrina E Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | | | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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Fleming T, Ivsins A, Barker A, Mansoor M, Mayer S, Vakharia S, McNeil R. Perceptions of prospective pharmaceutical stimulant substitution treatments among people who use illicit stimulants in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 125:104336. [PMID: 38281384 PMCID: PMC11045237 DOI: 10.1016/j.drugpo.2024.104336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Stimulant-involved overdose deaths are increasing, driven by polysubstance use and adulteration of the illicit drug supply. While emerging evidence for prescription stimulant substitution is promising, there are no approved treatment options for stimulant use disorder that address the realities of an unpredictable drug supply. This study explores treatment experiences of people who use illicit stimulants (PWUS) to identify gaps and perceptions of prospective pharmaceutical stimulant substitution treatments (SST). METHODS In-depth qualitative interviews were conducted with 86 PWUS in Vancouver, Canada. Thematic analysis focused on experiences of available treatment options for stimulant use and perceptions of prospective SST. RESULTS Participants identified how primarily behavioral treatment approaches do not meet the unique needs of PWUS, in contrast with the range of medical treatments available for opioid use disorder. Participants anticipated health and social benefits if they were able to access SST, including avoiding the toxic illicit stimulant supply, reduced engagement in criminalized activities, and greater economic security. Perceptions of prospective SST were informed by knowledge of existing opioid treatments. This led some participants to be unsupportive of SST, citing concerns around agency and highly regulated operational contexts that do not align with the lived realities of stimulant use. CONCLUSION Findings demonstrate the need for SST pilot programs in real-world settings and underscore the health and social advantages SST may offer; although drawing on existing opioid treatment models to implement SST pilots may limit success. Thus, any novel treatments for stimulant use must centre the lived realities of PWUS.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Andrew Ivsins
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Allison Barker
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Manal Mansoor
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Sheila Vakharia
- Drug Policy Alliance, 131 West 33rd Street, 15th Floor, New York, NY 10001, USA
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA; Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA.
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Clifford B, Van Gordon K, Magee F, Malone V, Siefried KJ, Graham D, Ezard N. "There's a big tag on my head": exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia. BMC Health Serv Res 2023; 23:162. [PMID: 36793060 PMCID: PMC9933255 DOI: 10.1186/s12913-023-09125-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Australia has a high prevalence of regular use of methamphetamine. While half of people who use methamphetamine regularly are women, they make up only one third of people seeking treatment for methamphetamine use disorder. There is a lack of qualitative research into the facilitators and barriers to treatment for women who use methamphetamine regularly. The study seeks a better understanding of the experiences and treatment preferences of women who use methamphetamine, to inform person-centred changes in practice and policy that break down barriers to treatment. METHODS We conducted semi-structured interviews with 11 women who frequently use methamphetamine (at least once a week), and who are not engaged in treatment. Women were recruited from health services surrounding a stimulant treatment centre at an inner-city hospital. Participants were asked about their methapmhetamine use and health service needs and preferences. Thematic analysis was completed using Nvivo® software. RESULTS Three themes were developed from participants' responses around experiences of regular methamphetamine use and treatment needs: 1. Resistance of stigmatised identity including dependence; 2. Interpersonal violence; 3. Institutionalised stigma. A fourth set of themes on service delivery preferences were also elicited, including continuity of care, integrated health care, and provision of non-judgmental services. CONCLUSION Gender-inclusive health care services for people who use methamphetamine should actively work to address stigma, support a relational approach to assessment and treatment, and seek to provide structurally competent health care that is trauma and violence informed, and integrated with other services. Findings may also have application for substance use disorders other than methamphetamine.
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Affiliation(s)
- Brendan Clifford
- Alcohol & Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia. .,National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales, Australia. .,Drug and Alcohol Clinical Research and Improvement Network, Sydney, New South Wales, Australia. .,National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia.
| | - Kate Van Gordon
- Victor Medical Centre, Victor Harbor, South Australia Australia
| | - Fiona Magee
- grid.477714.60000 0004 0587 919XSouth Eastern Sydney Local Health District, Sydney, New South Wales Australia
| | - Victoria Malone
- grid.437825.f0000 0000 9119 2677Alcohol & Drug Service, St Vincent’s Hospital Sydney, Sydney, New South Wales Australia
| | - Krista J. Siefried
- grid.437825.f0000 0000 9119 2677Alcohol & Drug Service, St Vincent’s Hospital Sydney, Sydney, New South Wales Australia ,grid.508539.2National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - Duncan Graham
- grid.508539.2National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales Australia
| | - Nadine Ezard
- grid.437825.f0000 0000 9119 2677Alcohol & Drug Service, St Vincent’s Hospital Sydney, Sydney, New South Wales Australia ,grid.508539.2National Centre for Clinical Research on Emerging Drugs of Concern, Sydney, New South Wales Australia ,Drug and Alcohol Clinical Research and Improvement Network, Sydney, New South Wales Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, Australia
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Nyashanu M, Brown M, Nyashanu T, Frost D. Exploring treatment barriers on the use of crystal methamphetamine among young people in Harare, Zimbabwe. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2173097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Mathew Nyashanu
- Institute of Health & Allied Professions, Nottingham Trent University, Nottingham, UK
| | - Michael Brown
- Institute of Health & Allied Professions, Nottingham Trent University, Nottingham, UK
| | - Ticahaenzana Nyashanu
- Faculty of Humanities, Department of Psychology, University of Pretoria, Hatfield, South Africa
| | - Diana Frost
- School of Business, Nottingham Trent University, Nottingham, UK
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Black E, Mammen K, Deacon RM, Ezard N, Mills L, Dunlop AJ, Montebello M, Reid D, Childs S, Bruno R, Shakeshaft A, Siefried KJ, Farrell M, Holmes J, Lintzeris N. Health and social characteristics of clients reporting amphetamine type substance use at entry to public alcohol and other drug services in New South Wales, Australia, 2016-2019. Drug Alcohol Rev 2023; 42:389-400. [PMID: 36524444 PMCID: PMC10107800 DOI: 10.1111/dar.13588] [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: 07/06/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Amphetamine type substances (ATS) are commonly used by Australian alcohol and other drug service entrants. We describe demographic characteristics, patterns of ATS and other substance use, health and social conditions among clients entering New South Wales (NSW) public alcohol and other drug services. METHODS Retrospective cohort of 13,864 records across six health districts (2016-2019) for clients seeking substance use treatment. These districts service approximately 44% of the NSW population aged 15 years and over. Multivariate analysis was conducted on a subsample for whom full data were available (N = 9981). Data included NSW Minimum Data Set for drug and alcohol treatment services and Australian Treatment Outcomes Profile items. RESULTS Over the preceding 4 weeks, 77% (n = 10,610) of clients (N = 13,864) reported no recent ATS use, 15% (n = 2109) reported 'low frequency' (1-12 days) and 8% (n = 1145) 'high frequency' (13-28 days) use. ATS use was most common among people attending for ATS or opioids as primary drug of concern. A multinomial regression (N = 9981) identified that clients reporting recent arrest (aOR 1.74, 95% CI 1.36, 2.24), higher cannabis use frequency (aOR 1.01, 95% CI 1.00, 1.02), lower opioid use frequency (aOR 0.98, 95% CI 0.97, 0.99) and poorer quality of life (aOR 0.91, 95% CI 0.86, 0.97) were more likely to report 'high frequency' rather than 'low frequency' ATS use. DISCUSSION AND CONCLUSIONS People who use ATS experience health and social issues that may require targeted responses. These should be integrated across all services, not only for clients with ATS as principal drug of concern.
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Affiliation(s)
- Emma Black
- Drug and Alcohol Services, South Eastern Sydney Local Health DistrictSydneyAustralia
- Specialty of Addiction MedicineThe University of SydneySydneyAustralia
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Kristie Mammen
- Drug and Alcohol Services, South Eastern Sydney Local Health DistrictSydneyAustralia
| | - Rachel M. Deacon
- Drug and Alcohol Services, South Eastern Sydney Local Health DistrictSydneyAustralia
- Specialty of Addiction MedicineThe University of SydneySydneyAustralia
| | - Nadine Ezard
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- Alcohol and Drug Service, St Vincent's HospitalSydneyAustralia
- National Centre for Clinical Research on Emerging DrugsSydneyAustralia
- NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Ministry of HealthSydneyAustralia
| | - Llewellyn Mills
- Drug and Alcohol Services, South Eastern Sydney Local Health DistrictSydneyAustralia
- Specialty of Addiction MedicineThe University of SydneySydneyAustralia
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Adrian J. Dunlop
- NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Ministry of HealthSydneyAustralia
- Drug and Alcohol Clinical Services, Hunter New England Local Health DistrictNewcastleAustralia
- School of Medicine and Public HealthCollege of Health & Wellbeing, University of NewcastleNewcastleAustralia
- HMRI Healthcare Transformation Research ProgramNewcastleAustralia
| | - Mark Montebello
- Specialty of Addiction MedicineThe University of SydneySydneyAustralia
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Ministry of HealthSydneyAustralia
- Drug and Alcohol Services, North Sydney Local Health DistrictSydneyAustralia
| | - David Reid
- NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Ministry of HealthSydneyAustralia
- Drug and Alcohol Services, Illawarra and Shoalhaven Local Health DistrictWollongongAustralia
| | - Steven Childs
- NSW Drug and Alcohol Clinical Research and Improvement Network, NSW Ministry of HealthSydneyAustralia
- Drug and Alcohol Services, Central Coast Local Health DistrictGosfordAustralia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- School of Psychological SciencesUniversity of TasmaniaHobartAustralia
| | | | - Krista J. Siefried
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- Alcohol and Drug Service, St Vincent's HospitalSydneyAustralia
- National Centre for Clinical Research on Emerging DrugsSydneyAustralia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Jennifer Holmes
- Centre for Alcohol and other Drugs, NSW Ministry of HealthSydneyAustralia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health DistrictSydneyAustralia
- Specialty of Addiction MedicineThe University of SydneySydneyAustralia
- Drug and Alcohol Services, Illawarra and Shoalhaven Local Health DistrictWollongongAustralia
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Evaluation of the BEAT Meth Intervention for Emergency Department Patients with Methamphetamine Psychosis. J Addict Med 2023; 17:67-73. [PMID: 35802766 DOI: 10.1097/adm.0000000000001037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Methamphetamine is the second leading cause of overdose death in America and a leading cause of emergency department (ED) visits. Methamphetamine-induced psychosis is a dangerous and difficult-to-treat consequence of methamphetamine use. We describe the pilot implementation and outcomes of a multimodal treatment intervention for ED patients with methamphetamine psychosis, Beginning Early and Assertive Treatment for Methamphetamine Psychosis (BEAT Meth). METHODS BEAT Meth was implemented in an urban safety net health system. The protocol includes early identification and treatment of methamphetamine psychosis, a protocolized hospitalization, and support for transitioning patients to specialty addiction treatment. Patients receiving BEAT Meth were compared with ED patients with methamphetamine psychosis who were discharged. Implementation fidelity was measured to assess feasibility. RESULTS BEAT Meth patients were nearly 3 times more likely to attend an outpatient specialty addiction appointment in the 30 days after discharge than comparison patients (32% vs 11%, P < 0.01). Subsequent ED utilization was common among all patients, and there was no significant difference in 30-day ED return rates between BEAT Meth and comparison patients (28% vs 37%, P = 0.10). Exploratory analyses suggested that increased attendance at outpatient treatment reduced ED utilization. CONCLUSIONS BEAT Meth is an intervention framework to support identification, management, and treatment engagement of ED patients with methamphetamine psychosis. Treatment strategies like BEAT Meth are necessary to manage the unique challenges of methamphetamine addiction. These findings will guide clinical care, program development, and research.
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Uthurralt N, Miao Cao F, Reid SE, Nithyanandam L, Burns L, Day CA. Characteristics of clients entering women-only substance use treatment services in New South Wales. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231200133. [PMID: 37921428 PMCID: PMC10625314 DOI: 10.1177/17455057231200133] [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: 04/05/2023] [Revised: 07/23/2023] [Accepted: 08/22/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Women experiencing substance use disorders face barriers to treatment, including childcare, stigma and lack of gender/trauma-informed programming. Several non-government organizations in New South Wales run women-only treatment services to address these needs. OBJECTIVES We aim to assess characteristics of women entering treatment in these services. DESIGN Data on client characteristics from six women-only non-government organization substance use disorder treatment services in New South Wales between 2014 and 2018 were extracted from a database containing demographics, drug use and treatment characteristics and psychological distress (Kessler-10 scale) of women entering the services. Logistic regression models were used to estimate unadjusted odds ratio and adjusted odds ratio for treatment completion and different drugs on entry. RESULTS Data were available for 1357 women. Most (91%) episodes were for residential treatment. Women's mean age was 35.4 years (standard deviation = 9.8; range = 17-67). Residential clients tended to be younger than non-residential clients (35.1 vs 38.5 years, p < 0.001). Methamphetamine (43%) and alcohol (32%) were the most reported principal drug of concern. Women (89%) reported high levels of psychological distress (median Kessler-10 scale score = 27.5, range = 10-50), highest for women reporting alcohol as their principal drug. Overall, 43% of episodes resulted in treatment completion, most commonly for women entering residential treatment (45% vs 22%, p < 0.001) and for alcohol treatment (adjusted odds ratio = 1.42; confidence interval = 1.07-1.90; p < 0.001). Women with Kessler-10 scale scores indicating anxiety or depression at treatment entry were less likely to complete treatment than those with lower scores (adjusted odds ratio = 0.56; confidence interval = 0.38-0.80; p < 0.001). CONCLUSION Women entering women-only residential treatment tend to be younger and report methamphetamine as principal drug of concern. Women enter treatment with high degrees of psychological distress. Women's services need to ensure their programmes can respond to diverse needs of younger women presenting with methamphetamine use disorder and older women with alcohol use disorder experiencing high levels of psychological distress.
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Affiliation(s)
- Natalia Uthurralt
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Felicia Miao Cao
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sharon E Reid
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | | | - Lucy Burns
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - Carolyn A Day
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
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A measure of subjective substance use disorder awareness - Substance Use Awareness and Insight Scale (SAS). Drug Alcohol Depend 2022; 231:109129. [PMID: 35042153 DOI: 10.1016/j.drugalcdep.2021.109129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Impaired illness awareness or inability to recognize that one has a substance use disorder can be a barrier to treatment seeking and rehabilitation. A validated scale is needed to better understand the clinical impact of impaired substance use disorder awareness. This study aimed to examine the psychometric properties of the Substance Use Awareness and Insight Scale (SAS), a novel scale to assess impaired illness awareness in individuals with substance use disorder. METHODS We developed the SAS, a 7-item self-report measure to assess the theoretical constructs of illness awareness in substance use disorder (www.illnessawarenessscales.com). Participants 18 years of age or older with a score of 8 or more on the Drug Use Disorders Identification Test (DUDIT) were included. Data were collected via Dynata, an online survey platform. RESULTS A total of 299 participants were included (mean (SD) age = 47.3-years (15.4), 54% women). The SAS demonstrated good convergent (r = 0.82, p < 0.001) and discriminant validity (r = -0.23, p < 0.001) with a measure of illness recognition and positive affect, respectively. SAS also demonstrated good internal consistency (Cronbach's alpha = 0.86) and one-month test-retest reliability (intra-class correlation = 0.87). An exploratory factor analysis suggested the retention of two components. Separate analyses of the SAS in individuals with cannabis, opioid, and other substance use showed similar results. DISCUSSION The results of this study provide initial support for the psychometric validation of the SAS in adults with substance use disorder. The SAS holds promise for use in research and clinical settings to assess the influence of impaired substance use disorder awareness on treatment outcomes.
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Murnion B, Dhaliwal A, Alsop J. Patient characteristics predicting attendance for elective in-patient treatment of substance use disorder. Australas Psychiatry 2021; 29:659-662. [PMID: 34266292 DOI: 10.1177/10398562211025034] [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: 11/16/2022]
Abstract
OBJECTIVE Consumption of alcohol and other drugs constitutes a significant health burden. Treatment access is poor, and a number of barriers are recognised. The objective of this retrospective cohort study is to examine patient characteristics of those attending/not attending for elective in-patient withdrawal management (IWM). METHODS Records of all elective admissions for IWM between 1 March and 30 June 2019 were reviewed. Data were extracted on attendance, age, substance(s) used, pre-arranged rehabilitation admissions following discharge, wait time, legal issues and child welfare agency involvement. RESULTS Of 274 planned admissions, 193 (70%) attended. Attendance was predicted by residential treatment planned after withdrawal management and older age. People using amphetamines were less likely to attend. CONCLUSION There are low attendance rates for elective IWM. Patient characteristics predicting lower attendance include younger age, amphetamine use and not planning rehabilitation. Further research is required to improve attendance.
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Affiliation(s)
- Bridin Murnion
- Drug and Alcohol Services, Central Coast Local Health District, Australia.,School of Medicine and Public Health, University of Newcastle, Australia
| | - Anupreet Dhaliwal
- Drug and Alcohol Services, Central Coast Local Health District, Australia
| | - Julian Alsop
- Drug and Alcohol Services, Central Coast Local Health District, Australia
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Guerin AA, Kim JH. Age of Onset and Its Related Factors in Cocaine or Methamphetamine Use in Adults from the United States: Results from NHANES 2005-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12259. [PMID: 34832019 PMCID: PMC8618538 DOI: 10.3390/ijerph182212259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022]
Abstract
Cocaine and methamphetamine are widely used illicit psychostimulants worldwide, with steadily increasing global markets that may impact on the frequency of use. Importantly, their use typically begins in youth. This is a particular concern because there is a link between the early age of first substance use and severity of substance use disorder later in life. The aim of the present study was therefore to investigate trends in prevalence, frequency, and age of onset of cocaine or methamphetamine use between 2005 and 2018 in the United States, using the nationally representative NHANES datasets. Factors associated with the ages of cocaine or methamphetamine use onset were also identified. From 2005 to 2018, prevalence and frequencies of cocaine or methamphetamine use increased, while age of onset remained relatively stable (~20 years of age). Annual household income, use of other substances, and intravenous drug use were identified as factors associated with early onset cocaine or methamphetamine use. These factors have important implications toward developing new prevention programs to reduce psychostimulant use.
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Affiliation(s)
- Alexandre Arthur Guerin
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Mental Health Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3052, Australia
| | - Jee Hyun Kim
- Mental Health Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3052, Australia
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC 3220, Australia
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Ghouchani HT, Lashkardoost H, Saadati H, Hojjat SK, Kaviyani F, Razaghi K, Asghari D, Gholizadeh N. Developing and validating a measurement tool to self-report perceived barriers in substance use treatment: the substance use treatment barriers questionnaire (SUTBQ). Subst Abuse Treat Prev Policy 2021; 16:82. [PMID: 34743748 PMCID: PMC8573928 DOI: 10.1186/s13011-021-00419-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance using often cause a wide range of social, health, and psychological problems. This study aimed to develop and validate a questionnaire of barriers of treatment in substance users. METHODS In this cross-sectional study, the initial questionnaire was designed based on the evaluation of previous studies. The preliminary tool including 35 Likert-scaled items. After assuring the face validity of the questionnaire, 13 experts' opinions were obtained for assessing or improving the content validity. The reliability was investigated by internal consistency methods using Cronbach's alpha. For measuring the structural validity, the exploratory factor analysis was performed to determine the dimensionality of the questionnaire using principal components extraction and Varimax rotation. RESULTS The preliminary questionnaire consisted of 35 items. After completing the face validity and summarizing the experts' suggestions, 8 items were removed. By calculating the content validity ratio and coefficient, 11 questions were deleted. The internal consistency was calculated to be 0.84 using Cronbach's alpha. In the last stage and according to the results of the factor analysis, three factors fear of or unawareness of treatment, doubt or inefficiency, and social stigma were identified from the 10-items questionnaire, which explained 67.34% of the total variance. CONCLUSION Considering the necessity of using a validated tool for planning and evaluating effective interventions on people who use substance is inevitable. The Substance use Treatment Barriers Questionnaire is designed with 10 items and 3 dimensions, which has appropriate validity and reliability and can be used to determine the obstacles for treatment or factors that lead to discontinuing treatment.
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Affiliation(s)
- Hamid Tavakoli Ghouchani
- Addiction and Behavioral Sciences Research Center & Department of Health Education and Promotion, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hossein Lashkardoost
- Addiction and Behavioral Sciences Research Center & Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hassan Saadati
- Addiction and Behavioral Sciences Research Center & Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran.
| | - Seyed Kaveh Hojjat
- Addiction & Behavioral Sciences Research Center, Department of Internal Medicine, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Division of sleep medicine, Psychiatry and Behavioral sciences research center, Mashhad university of medical sciences, Mashhad, Iran
| | - Faezeh Kaviyani
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Kazem Razaghi
- PhD, Lecturer, School of Nursing, Midwifery and Paramedicine NSW/ACT, Australian Catholic University, Sydney, Australia
| | - Dordane Asghari
- Measurement & Measurement Field (Psychometric Field), Addiction & Behavioral Sciences Research Center (Researcher), Bojnurd, Iran
| | - Nazanin Gholizadeh
- General Psychology, Addiction & Behavioral Sciences Research Center, Bojnurd, Iran
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12
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Anderson J. Peer support workers’ conceptions of drug users and the implications for service provision. Anthropol Med 2021; 28:477-492. [DOI: 10.1080/13648470.2021.1875317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jane Anderson
- Anthropology and Sociology, Faculty of Arts, Humanities and Social Sciences, The University of Western, Crawley, Australia
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13
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Tavakoli Ghouchani H, Armat MR, Akbari H, Hojjat SK, Lashkardoost H, Asghari D, Gholizadeh N, Saadati H. Perceived barriers to addiction treatment: an inductive qualitative content analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1967482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hamid Tavakoli Ghouchani
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Department of Health Education and Promotion, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mohammad Reza Armat
- Department of Geriatric Nursing, School of Nursing and Midwifery, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hadi Akbari
- Department of General Courses and Islamic Studies, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Seyed Kaveh Hojjat
- Addiction & Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Department of Internal Medicine, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hossein Lashkardoost
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Dordane Asghari
- Measurement & Measurement Field (Psychometric Field), Addiction & Behavioral Sciences Research Center (Researcher), Bojnurd, Iran
| | - Nazanin Gholizadeh
- General Psychology, Addiction & Behavioral Sciences Research Center, Bojnurd, Iran
| | - Hassan Saadati
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Department of Epidemiology and Biostatistics, School of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
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14
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Beck AK, Larance B, Deane FP, Baker AL, Manning V, Hides L, Shakeshaft A, Argent A, Kelly PJ. The use of Australian SMART Recovery groups by people who use methamphetamine: Analysis of routinely-collected nationwide data. Drug Alcohol Depend 2021; 225:108814. [PMID: 34174775 DOI: 10.1016/j.drugalcdep.2021.108814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Mutual support groups (e.g. SMART Recovery) are an important source of support for people experiencing addictive behaviours. Little is known about the use of mutual support groups by people who use methamphetamine, or the factors that may influence group cohesion. METHODS This study uses post-group data reported by SMART Recovery facilitators in Australia between 2018 and 2020. Group cohesion was indexed by facilitator ratings of The Group Entitativity measure (GEM-GP). Participant characteristics (gender, age, new or returning group member, voluntary or mandated attendance) and group location (major city vs. regional/remote vs. online) were used to (a) compare methamphetamine and non-methamphetamine related attendances; and (b) explore relationships to group cohesion within groups where the majority attended for methamphetamine. RESULTS Methamphetamine use was the second most common reason for attending SMART Recovery groups (n = 4929; 22.2 % service occasions). Methamphetamine-related service occasions were more likely amongst men, people aged <45 years, returning attendees and regional/rural groups (allp < .05). GEM-GP scores were high (signalling strong cohesion), and did not significantly differ according to proportion of participants attending for methamphetamine (F(1,2) = 0.482, p = .618). Group cohesion increased with larger group size, proportion of women and proportion of younger people (F(4, 504) = 11.058, p < .001)). DISCUSSION AND CONCLUSIONS This study improves current understanding of service utilisation by people who use methamphetamine. SMART Recovery groups offer an avenue for supporting a diverse range of people who use methamphetamine, outside the formal treatment system. This provides an important foundation for improving community support options for people who use methamphetamine.
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Affiliation(s)
- Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia.
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Victoria Manning
- Monash Addiction Research Centre (MARC), Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | | | - Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
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15
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Cornwell DQ, Thompson AR, Ivie RM, Working ZM, Friess DM, Meeker JE. Methamphetamine in Orthopaedics: Considerations of an At-Risk Population. JBJS Rev 2021; 9:01874474-202106000-00012. [PMID: 34550663 DOI: 10.2106/jbjs.rvw.20.00229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Methamphetamine use by orthopaedic trauma patients has risen to epidemic proportions. » Perioperative methamphetamine use by orthopaedic trauma patients requires physicians to consider both medical and psychosocial factors during treatment. » Behavioral and psychosocial effects of methamphetamine use present barriers to care. » Patients who use methamphetamine face elevated rates of complications.
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Affiliation(s)
- David Q Cornwell
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland,
| | - Austin R Thompson
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland,
| | - Ryan M Ivie
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Zachary M Working
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland,
| | - Darin M Friess
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland,
| | - James E Meeker
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland,
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16
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Singh D, Narayanan S, Shanmugam T, Vicknasingam B. Treatment Barriers Associated with Amphetamine-Type Stimulant (ATS) Use in Malaysia. J Psychoactive Drugs 2021; 54:25-33. [PMID: 33749541 DOI: 10.1080/02791072.2021.1900627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People who use amphetamine-type stimulant (ATS) are known to face barriers in seeking treatment. We sought to identify these barriers and gender differences in barriers (if any) faced by them. A convenience sample of 386 respondents who use ATS was recruited from five formal drug rehabilitation centers for this cross-sectional study. The majority were male (83%), with 17% being female. The barriers most frequently cited by both men and women were: the perception that ATS use needed no treatment, fears of community discrimination, peer influence, and long waiting time to get into a treatment programme. One-third of the sample held that the mandated treatment programmes were ineffective, based on past experience. In terms of male-female differences, long waiting time discouraged significantly more women than men, whereas more men than women asserted that formal treatment programmes were ineffective. We also found no significant differences in barriers faced by ATS users and those using ATS with other illicit substances. Outreach initiatives to minimize the impact of treatment barriers, coupled with offering separate treatment protocols and facilities, will encourage people who use ATS to seek treatment voluntarily.
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Affiliation(s)
- Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia. Minden, Penang, Malaysia
| | - Suresh Narayanan
- School of Social Sciences, Universiti Sains Malaysia. Minden, Penang, Malaysia
| | - Thorairaj Shanmugam
- Centre for Drug Research, Universiti Sains Malaysia. Minden, Penang, Malaysia
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17
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Axelsson M, Snell TL. Breaking the ice: narratives of recovery from crystal methamphetamine. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1893600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Martin Axelsson
- Faculty of Education , Monash University, Clayton, Australia
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18
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Raftery D, Kelly PJ, Deane FP, Baker AL, Ingram I, Goh MCW, Lubman DI, Carter G, Turner A, Dean OM, Sinclair BL, McKetin R. Insight in substance use disorder: A systematic review of the literature. Addict Behav 2020; 111:106549. [PMID: 32731008 DOI: 10.1016/j.addbeh.2020.106549] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 05/22/2020] [Accepted: 07/08/2020] [Indexed: 01/12/2023]
Abstract
Insight refers to a person's understanding of themselves and the world around them. Recent literature has explored people's insight into their substance use disorder (SUD) and how this is linked to treatment adherence, abstinence rates, and comorbid mental health symptoms. The aim of this systematic review was to synthesise and critically examine the existing literature on insight in SUD. Five academic databases (Medline, PsychINFO, SCOPUS, CINAHL, Web of Science) were searched for key terms related to insight and substance use. Included studies were on humans aged 18 years or over with SUD that examined the relationship between substance use and insight using a quantifiable measure of insight. Of 10,067 identified papers, 20 met the inclusion criteria, employing 13 different measures of insight. The most commonly used measure was the Hanil Alcohol Insight Scale (HAIS) which was the only measure designed for a substance use population and was specific to alcohol use. Based on a pooled sample from five studies (n = 585), 57% of participants had poor insight, 36% had fair insight, and 7% had good insight on the HAIS. Better insight was generally related to negative consequences from substance use, better treatment adherence and maintaining abstinence. Insight appears to be an important factor to consider within SUD. Exploring the most appropriate way to measure insight and assess its role in SUD has implications for intervention design, and engaging and maintaining people with SUD in treatment.
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Affiliation(s)
- Dayle Raftery
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia.
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Isabella Ingram
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia
| | - Melvin C W Goh
- School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, NSW, Australia
| | - Dan I Lubman
- Eastern Health Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | - Greg Carter
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Alyna Turner
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia; Centre for Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Olivia M Dean
- Centre for Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Barbara L Sinclair
- Illawarra Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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19
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Murphy CE, Wang RC, Coralic Z, Lai AR, Raven M. Association Between Methamphetamine Use and Psychiatric Hospitalization, Chemical Restraint, and Emergency Department Length of Stay. Acad Emerg Med 2020; 27:1116-1125. [PMID: 32713087 DOI: 10.1111/acem.14094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Methamphetamine intoxication is an increasing cause of emergency department (ED) visits in the United States, particularly in the west. In San Francisco, California, 47% of patients visiting psychiatric emergency services are intoxicated with methamphetamine. Such patients often visit the ED due to acute psychiatric symptoms, yet ED-based research investigating the outcomes and resource utilization of these visits is limited. METHODS We examined a retrospective cohort of ED patients requiring ED-based psychiatric consultation from June 2017 to July 2018. We evaluated the association between methamphetamine visits and need for chemical restraint, psychiatric hospitalization, and length of stay (LOS). RESULTS We identified 2,087 ED visits with psychiatric consults. Based on urine toxicology results and discharge diagnosis, 403 visits involved methamphetamine with or without other drugs, 480 involved other drugs without methamphetamine, and 1,204 had no evidence of drug use. Methamphetamine visits were associated with increased odds of chemical restraint compared to visits without drug use (adjusted odds ratio [AOR] = 3.2, 95% CI = 2.1 to 5.2, p < 0.001), but not other drug visits (AOR = 1.2, 95% CI = 0.8 to 1.9, p = 0.4). Methamphetamine visits had lower odds of psychiatric hospitalization than other drug visits (AOR = 0.62, 95% CI = 0.41 to 0.95, p = 0.03) and longer adjusted LOS than visits without drug use (+4.3 hours, 95% CI = 4.1 to 8.3 hours, p < 0.001) but not other drug visits (+1.5 hours, 95% CI = -0.6 to 3.7 hours, p = 0.2). CONCLUSIONS Methamphetamine ED visits were associated with increased odds of needing chemical restraint and of an increased ED LOS but not with psychiatric inpatient admission. These results indicate an opportunity to improve the efficiency of ED care for these patients.
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Affiliation(s)
- Charles E. Murphy
- From the Department of Emergency Medicine University of California San Francisco CA USA
| | - Ralph C. Wang
- From the Department of Emergency Medicine University of California San Francisco CA USA
| | - Zlatan Coralic
- From the Department of Emergency Medicine University of California San Francisco CA USA
- the Department of Pharmacy University of California San Francisco CA USA
| | - Andrew R. Lai
- the Division of Hospital Medicine Department of Medicine University of California San Francisco CA USA
| | - Maria Raven
- From the Department of Emergency Medicine University of California San Francisco CA USA
- and the Philip R. Lee Institute for Health Policy Studies University of California San Francisco CA USA
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20
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Yangyuen S, Kanato M, Mahaweerawat C, Mahaweerawat U. The Perceived Stigma of Addiction and Treatment Utilization among Cannabis Addicts in Thailand. Indian J Community Med 2020; 45:492-496. [PMID: 33623208 PMCID: PMC7877418 DOI: 10.4103/ijcm.ijcm_532_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
Context: A major social problem among clients with substance use disorders is stigmatization related to health conditions, which contributes to poor mental and physical health circumstances and becomes hazardous to substance abuse treatment. Meanwhile, decreased stigmatization among cannabis users might occur because some people use cannabis without experiencing harm or believe it to be a harmless substance and might not be receiving treatment. Several studies have investigated stigma toward substance use disorder and treatment. However, less is known about how stigmatization influences treatment. Aims: To investigate the association between the perceived stigma of addiction and treatment utilization among cannabis addicts. Materials and Methods: A cross-sectional design was conducted with consecutive sampling techniques among 977 cannabis users recruited from all 7 compulsory drug detention centers in Thailand. The data were collected by standardized interviewers with a structured interviewing questionnaire. Binary logistic regression was applied to determine the effect of perceived stigma of treatment utilization. Results: Most clients were male (84.5%), had a family history of drug problems (54.5%), and had a history of mental health problems (5.1%). Most of them reported moderate-to-high levels of perceived stigma (87.2%) and received treatment (28.9%). Greater perceived stigma was associated with decreased treatment for cannabis abuse. Conclusions: The perceived stigma of addiction is a barrier to cannabis abuse treatment utilization. Thus, a better understanding of stigma could reduce its negative impact on seeking and engaging in treatment.
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Affiliation(s)
- Suneerat Yangyuen
- Department of Occupational Health and Safety, Faculty of Public Health, Mahasarakham University, Mahasarakham, Thailand
| | - Manop Kanato
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Udomsak Mahaweerawat
- Department of Occupational Health and Safety, Faculty of Public Health, Mahasarakham University, Mahasarakham, Thailand
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21
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Singh D, Saref N, Narayanan S, Griffin OH, Vicknasingam B. Treatment Compliance among Incarcerated and Fined Amphetamine-Type-Stimulant (ATS) Users in a Community Supervision Programme in Malaysia: A Preliminary Study. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1808724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Penang, Malaysia
| | - Nadiah Saref
- Centre for Drug Research, Universiti Sains Malaysia, Penang, Malaysia
| | - Suresh Narayanan
- School of Social Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - O. Hayden Griffin
- Department of Criminal Justice, University of Alabama at Birmingham, Birmingham, Alabama, USA
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22
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McKetin R, Voce A, Burns RA, Quinn B. The Short Barriers Questionnaire (SBQ): Validity, factor structure and correlates in an out-of-treatment sample of people dependent on methamphetamine. J Subst Abuse Treat 2020; 116:108029. [PMID: 32741495 DOI: 10.1016/j.jsat.2020.108029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/09/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND AIMS We validate a brief questionnaire to assess barriers to help-seeking for illicit substance use, and explore the factor structure and correlates of scale scores, among people dependent on methamphetamine. DESIGN AND METHODS We administered a modified version of 27 items from the Barriers Questionnaire to 145 adults who had used methamphetamine in the past month and who screened positive for methamphetamine dependence on the Mini International Neuropsychiatric Interview. We used an exploratory factor analysis to identify the scale's dimensions. We examined correlates of the scale scores, their internal consistency, and their concurrent validity against help-seeking intentions on the General Help Seeking Questionnaire (GHSQ). RESULTS A three factor model (χ2 = 308.6 df=168; RMSEA 0.08 [95% CI 0.06-0.09]; comparative fit index = 0.92) identified low perceived need for treatment (9 items), stigma (6 items), and apprehension about treatment (7 items) with Eigenvalues of 5.7, 3.8 and 2.3 respectively. The final 22-item scale had good internal consistency (Cronbach's alpha 0.83) and correlated negatively with help-seeking intentions on the GHSQ (rs = -0.24 p < .001) and positively with the GHSQ item, "I would not seek help from anyone" (rs = 0.38 p < .001). The scale dimensions of low perceived need, stigma, and apprehension had adequate to good internal consistency (Cronbach's alpha of 0.83, 0.79 and 0.69 respectively) but only low perceived need for treatment correlated significantly with the GHSQ scores. Low perceived need was also related to less severe methamphetamine dependence, not having children, and not having received professional help for methamphetamine use. Stigma was associated with specific demographics (being employed, having children), polysubstance use, and having attended sessions with a counselor or psychologist. Apprehension was associated with poor mental health, more severe substance use, being a woman, and having received help from an ambulance. DISCUSSION AND CONCLUSIONS This short version of the Barriers Questionnaire (the Short Barriers Questionnaire; SBQ) is an internally consistent and valid scale for assessing low perceived need for treatment among people who use methamphetamine. Further work is needed to capture and validate other barriers to help-seeking for this population.
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Affiliation(s)
- Rebecca McKetin
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
| | - Alexandra Voce
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Richard A Burns
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Brendan Quinn
- Longitudinal and Lifecourse Studies, Australian Institute of Family Studies, Southbank, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
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23
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Allan J, Ip RHL, Kemp M, Snowdon N. Increased demand for amphetamine treatment in rural Australia. Addict Sci Clin Pract 2019; 14:13. [PMID: 30929641 PMCID: PMC6442410 DOI: 10.1186/s13722-019-0144-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/14/2019] [Indexed: 11/19/2022] Open
Abstract
Background A substantial increase in substance treatment episodes for methamphetamine problems suggests characteristics of the treatment population could have changed and that targeted treatment programs are required. To determine who methamphetamine treatment should be designed for this study has two aims. First, to empirically describe changes in amphetamine treatment presentations to a rural NSW drug and alcohol treatment agency over time. Second, to examine how these characteristics may affect the likelihood of being treated for amphetamines compared to other drugs. Method The Australian Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) containing closed treatment episodes from a single agency from three time periods was used. Characteristics of people receiving amphetamine treatments in these three periods were compared and the effects of these characteristics on the odds of being treated for amphetamine were estimated using a logistic regression model. The characteristics utilised in the analysis include age, sex, Indigenous status, usual accommodation, living arrangement, source of referral and source of income. Results The proportion of amphetamine treatment episodes doubled from 2006/2007 to 2015/2016 and overtook alcohol as the most commonly treated principal drug of concern. The estimated proportion of amphetamine treatments showed an increment across all ages and for men and women. It was found that younger people, women, people in temporary accommodation or homeless, people who were self-referred and people whose main source of income was not through employment are more likely to be treated for amphetamine use. Conclusion Significant changes over time in the age, sex and Indigenous status of people receiving treatment for amphetamine as the principal drug of concern requires service delivery to match demand from younger people, particularly women; and Indigenous people. The needs and preferences for treatment of younger women who use amphetamine will be important factors in treatment planning service providers who are more used to providing treatment for young men who use cannabis and older men who use alcohol. Further research on women’s experiences in treatment and outcomes would be useful for informing treatment practices. Electronic supplementary material The online version of this article (10.1186/s13722-019-0144-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julaine Allan
- Lives Lived Well, Orange, NSW, Australia. .,Conjoint Academic, National Drug and Alcohol Research Centre, UNSW, P.O. Box 9374, Orange East, NSW, 2800, Australia.
| | - Ryan H L Ip
- Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Michael Kemp
- Charles Sturt University, Orange, NSW, Australia
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Lee NK, Jenner L, Harney A, Cameron J. Pharmacotherapy for amphetamine dependence: A systematic review. Drug Alcohol Depend 2018; 191:309-337. [PMID: 30173086 DOI: 10.1016/j.drugalcdep.2018.06.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Demand for treatment for amphetamine use is increasing internationally. Establishing effective pharmacotherapy provides broader treatment options for people who are dependent on amphetamine and may encourage engagement in evidence-based behavioral treatment. This study aimed to identify medicines that have potential in improving treatment outcomes for people who are dependent on amphetamines. METHODS Medline, PsycINFO, Embase and the Cochrane Database of Systematic Reviews were searched from 1997 to 2012 and again from 2013 to 2016. Studies on medications for amphetamine/methamphetamine dependence treatment were selected and assessed by two independent researchers. A meta-narrative review approach was used to synthesize results. RESULTS A total of 49 studies investigating 20 potential pharmacotherapies were eligible for inclusion. Of these, 35 studies related to 33 level II quality randomized controlled trials (RCTs). Five medications were subject to multiple RCTs. Four of these medicines demonstrated some limited evidence of benefit for reducing amphetamine use: methylphenidate (as reported in three studies), bupropion (in three studies), modafinil (two studies), and naltrexone (one study). Four RCTs of dexamphetamine suggest its benefit on secondary outcomes such as treatment retention, but not for reducing amphetamine use. Six other medicines indicate the potential for efficacy, but the number of studies is too small to draw conclusions. CONCLUSIONS No medicine has as yet demonstrated sufficient, consistent evidence of effectiveness to support its use in routine treatment. High study drop-out and poor medication adherence limits the strength of evidence and raises important clinical questions about how to improve treatment engagement and outcomes.
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Affiliation(s)
- Nicole K Lee
- National Drug Research Institute, Curtin University, 7 Parker Place, Bentley, WA, 6102, Australia; 360Edge Consulting, P.O. Box 359, Elwood, 3184, Victoria, Australia.
| | - Linda Jenner
- 360Edge Consulting, P.O. Box 359, Elwood, 3184, Victoria, Australia
| | - Angela Harney
- 360Edge Consulting, P.O. Box 359, Elwood, 3184, Victoria, Australia
| | - Jacqui Cameron
- 360Edge Consulting, P.O. Box 359, Elwood, 3184, Victoria, Australia; Department of General Practice, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, 3053, Australia
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25
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Alexander AC, Obong’o CO, Chavan PP, Dillon PJ, Kedia SK. Addicted to the ‘life of methamphetamine’: Perceived barriers to sustained methamphetamine recovery. DRUGS: EDUCATION, PREVENTION AND POLICY 2018. [DOI: 10.1080/09687637.2017.1282423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Adam C. Alexander
- School of Public Health, University of Memphis, Memphis, TN, USA and
| | | | - Prachi P. Chavan
- School of Public Health, University of Memphis, Memphis, TN, USA and
| | - Patrick J. Dillon
- School of Communication Studies, Kent State University, North Canton, OH, USA
| | - Satish K. Kedia
- School of Public Health, University of Memphis, Memphis, TN, USA and
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Hirakis E, Casey LM, Clough BA. Investigating Website Usability: Enhancing Engagement of Amphetamine Users in Online Treatment. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-017-9796-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lea T, Kolstee J, Lambert S, Ness R, Hannan S, Holt M. Methamphetamine treatment outcomes among gay men attending a LGBTI-specific treatment service in Sydney, Australia. PLoS One 2017; 12:e0172560. [PMID: 28207902 PMCID: PMC5313217 DOI: 10.1371/journal.pone.0172560] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 02/07/2017] [Indexed: 11/18/2022] Open
Abstract
Gay and bisexual men (GBM) report higher rates of methamphetamine use compared to heterosexual men, and thus have a heightened risk of developing problems from their use. We examined treatment outcomes among GBM clients receiving outpatient counseling at a lesbian, gay, bisexual, transgender and intersex (LGBTI)-specific, harm reduction treatment service in Sydney, Australia. GBM receiving treatment for methamphetamine use from ACON’s Substance Support Service between 2012–15 (n = 101) were interviewed at treatment commencement, and after 4 sessions (n = 60; follow-up 1) and 8 sessions (n = 32; follow-up 2). At each interview, clients completed measures of methamphetamine use and dependence, other substance use, injecting risk practices, psychological distress and quality of life. The median age of participants was 41 years and 56.4% identified as HIV-positive. Participants attended a median of 5 sessions and attended treatment for a median of 112 days. There was a significant reduction in the median days of methamphetamine use in the previous 4 weeks between baseline (4 days), follow-up 1 (2 days) and follow-up 2 (2 days; p = .001). There was a significant reduction in the proportion of participants reporting methamphetamine dependence between baseline (92.1%), follow-up 1 (78.3%) and follow-up 2 (71.9%, p < .001). There were also significant reductions in psychological distress (p < .001), and significant improvements in quality of life (p < .001). Clients showed reductions in methamphetamine use and improved psychosocial functioning over time, demonstrating the potential effectiveness of a LGBTI-specific treatment service.
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Affiliation(s)
- Toby Lea
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
- * E-mail:
| | | | | | - Ross Ness
- ACON, Sydney, New South Wales, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
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Sturman N, Saiepour N. Eligibility for opiate substitution therapy in recently released prisoners with high-risk amphetamine use, and their perceptions of its effectiveness. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1246622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nancy Sturman
- Discipline of General Practice, School of Medicine, Royal Brisbane Hospital, University of Queensland, Herston, Brisbane, Australia
| | - Nargess Saiepour
- School of Public Health, Royal Brisbane Hospital, University of Queensland, Herston, Brisbane, Australia
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Cumming C, Troeung L, Young JT, Kelty E, Preen DB. Barriers to accessing methamphetamine treatment: A systematic review and meta-analysis. Drug Alcohol Depend 2016; 168:263-273. [PMID: 27736680 DOI: 10.1016/j.drugalcdep.2016.10.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/26/2016] [Accepted: 10/01/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Methamphetamine use is associated with a range of poor health, social and justice outcomes. In many parts of the world increased methamphetamine use has been identified as a major public health concern. Methamphetamine treatment programmes have been effective in reducing and ceasing use, however a range of barriers have prevented these programmes being widely adopted by methamphetamine users. This review examines the barriers to accessing meth/amphetamine treatment identified in the literature. METHODS Databases were systematically searched using relevant terms for peer-reviewed articles describing original research exploring the barriers to accessing treatment for meth/amphetamine use. Reviews and grey literature were excluded. Eleven studies conducted in 5 countries were included in data synthesis; this involved a systematic review of all 11 studies, and meta-analysis of the prevalence of barriers reported in 6 studies that published sufficient quantitative data. RESULTS Psychosocial/internal barriers to accessing methamphetamine treatment were most prevalent across studies (10/11 studies). Meta-analysis confirmed the four most commonly endorsed barriers to treatment access across studies all psychosocial barriers were embarrassment or stigma (60%, 95% CI: 54-67%); belief that treatment was unnecessary (59%, 95% CI:54-65%); preferring to withdraw alone without assistance (55%, 95% CI:45-65); and privacy concerns (51%, 95% CI:44-59%). CONCLUSIONS The primary barriers to accessing methamphetamine treatment are psychosocial/internal. Services and treatment models that address these barriers are urgently required. There is a growing need for methamphetamine-appropriate treatment services. Further research evaluating treatment engagement and effectiveness for methamphetamine and polysubstance use, including the development of effective pharmacotherapies is warranted.
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Affiliation(s)
- Craig Cumming
- Centre for Health Service Research, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
| | - Lakkhina Troeung
- Centre for Health Service Research, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Jesse T Young
- Centre for Health Service Research, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie St, Carlton, Victoria 3053, Australia; National Drug Research Institute, Curtin University, Level 2, 10 Selby Street, Shenton Park, Western Australia 6008, Australia
| | - Erin Kelty
- Centre for Health Service Research, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - David B Preen
- Centre for Health Service Research, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
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Noori R, Daneshmand R, Farhoudian A, Ghaderi S, Aryanfard S, Moradi A. Amphetamine-Type Stimulants in a Group of Adults in Tehran, Iran: A Rapid Situation Assessment in Twenty-Two Districts. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2016. [DOI: 10.17795/ijpbs-7704] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Timko C, Schultz NR, Britt J, Cucciare MA. Transitioning From Detoxification to Substance Use Disorder Treatment: Facilitators and Barriers. J Subst Abuse Treat 2016; 70:64-72. [PMID: 27692190 DOI: 10.1016/j.jsat.2016.07.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/16/2016] [Accepted: 07/25/2016] [Indexed: 11/29/2022]
Abstract
Although successful transitions from detoxification to substance use disorder treatment are associated with improved outcomes, many detoxification patients do not initiate treatment. This qualitative study informs detoxification and addiction treatment providers, and health systems, about how to improve detoxification to treatment transitions, by reporting detoxification providers' views of transition facilitators and barriers. The sample consisted of 30 providers from 30 Veterans Health Administration detoxification programs. Themes regarding transition facilitators and barriers emerged at the patient, program (detoxification programs, and addiction programs), and system levels. Detoxification program-level practices of discharge planning, patient education, and rapport building were reported as facilitating the transition to treatment. Six themes captured transition facilitators within addiction treatment programs: the provision of evidence-based practices, patient-centered care, care coordination, aftercare, convenience, and a well-trained and professional staff. This study expands previous literature on detoxification and addiction treatment by systematically and qualitatively examining factors that promote and hinder treatment initiation after inpatient and outpatient detoxification, from a provider perspective, in an era of health care reform and expanded substance use disorder treatment.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation (Ci2i), Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Nicole R Schultz
- Department of Psychology, Auburn University, Auburn, AL 36849, USA.
| | - Jessica Britt
- Center for Innovation to Implementation (Ci2i), Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA 94304, USA; Clinical Psychology Graduate Program, Pacific Graduate School of Psychology-Stanford University Consortium, Palo Alto, CA 94304, USA.
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA; Veterans Affairs South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Methamphetamine use among gay and bisexual men in Australia: Trends in recent and regular use from the Gay Community Periodic Surveys. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 29:66-72. [DOI: 10.1016/j.drugpo.2016.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/09/2015] [Accepted: 01/06/2016] [Indexed: 12/22/2022]
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Quinn B, Stoové M, Dietze P. One-year changes in methamphetamine use, dependence and remission in a community-recruited cohort. JOURNAL OF SUBSTANCE USE 2015. [DOI: 10.3109/14659891.2015.1018972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Meade CS, Towe SL, Watt MH, Lion RR, Myers B, Skinner D, Kimani S, Pieterse D. Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: A mixed-methods study. Drug Alcohol Depend 2015; 152:79-86. [PMID: 25977205 PMCID: PMC4498803 DOI: 10.1016/j.drugalcdep.2015.04.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/15/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Since 2000, there has been a dramatic increase in methamphetamine use in South Africa, but little is known about the experiences of out-of-treatment users. This mixed-methods study describes the substance use histories, addiction symptoms, and treatment experiences of a community-recruited sample of methamphetamine users in Cape Town. METHODS Using respondent driven sampling, 360 methamphetamine users (44% female) completed structured clinical interviews to assess substance abuse and treatment history and computerized surveys to assess drug-related risks. A sub-sample of 30 participants completed in-depth interviews to qualitatively explore experiences with methamphetamine use and drug treatment. RESULTS Participants had used methamphetamine for an average of 7.06 years (SD=3.64). They reported using methamphetamine on an average of 23.49 of the past 30 days (SD=8.90); 60% used daily. The majority (90%) met ICD-10 criteria for dependence, and many reported severe social, financial, and legal consequences. While only 10% had ever received drug treatment, 90% reported that they wanted treatment. In the qualitative interviews, participants reported multiple barriers to treatment, including beliefs that treatment is ineffective and relapse is inevitable in their social context. They also identified important motivators, including desires to be drug free and improve family functioning. CONCLUSION This study yields valuable information to more effectively respond to emerging methamphetamine epidemics in South Africa and other low- and middle-income countries. Interventions to increase uptake of evidence-based services must actively seek out drug users and build motivation for treatment, and offer continuing care services to prevent relapse. Community education campaigns are also needed.
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Affiliation(s)
- Christina S Meade
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences and Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Sheri L Towe
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences and Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Melissa H Watt
- Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Ryan R Lion
- Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Box 19070, Tygerberg 7505, South Africa.
| | - Donald Skinner
- Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa.
| | - Stephen Kimani
- Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
| | - Desiree Pieterse
- Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa.
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Dean AC, Kohno M, Morales AM, Ghahremani DG, London ED. Denial in methamphetamine users: Associations with cognition and functional connectivity in brain. Drug Alcohol Depend 2015; 151:84-91. [PMID: 25840750 PMCID: PMC4447566 DOI: 10.1016/j.drugalcdep.2015.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/18/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite harmful consequences of drug addiction, it is common for individuals with substance use disorders to deny having problems with drugs. Emerging evidence suggests that some drug users lack insight into their behavior due to neurocognitive dysfunction, but little research has examined potential neurocognitive contributions to denial. METHODS This study explored the relationship between denial, cognitive performance and functional connectivity in brain. The participants were 58 non-treatment-seeking, methamphetamine-dependent participants who completed the URICA precontemplation scale, a self-report measure of denial of drug problems warranting change, as well as a cognitive test battery. A subset of participants (N = 21) had functional MRI scans assessing resting-state functional connectivity. Given literature indicating roles of the rostral anterior cingulate (rACC), anterior insula and precuneus in self-awareness, relationships between denial and resting-state connectivity were tested using seeds placed in these regions. RESULTS The results revealed a negative relationship between denial and an overall cognitive battery score (p = 0.001), the effect being driven particularly by performance on tests of memory and executive function. Denial was negatively associated with strength of connectivity between the rACC and regions of the frontal lobe (precentral gyri, left ventromedial prefrontal cortex, left orbitofrontal cortex), limbic system (left amygdala, left hippocampus and left parahippocampal gyrus), occipital lobes and cerebellum; and between the precuneus and the midbrain and cerebellum. Anterior insula connectivity was unrelated to denial. CONCLUSIONS These findings suggest that denial by methamphetamine users is linked with a cognitive and neural phenotype that may impede the development of insight into their behavior.
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Affiliation(s)
- Andy C. Dean
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA,Brain Research Institute, David Geffen School of Medicine, Los Angeles, CA, 90024, USA,Corresponding author: Andy C. Dean (), UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, United States of America 90095-1759, Tel: +1 310 825 5839; fax: +1 310 825 0812
| | - Milky Kohno
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA
| | - Angelica M. Morales
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA
| | - Dara G. Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA
| | - Edythe D. London
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience, David Geffen School of Medicine, Los Angeles, CA, 90024, USA,Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, Los Angeles, CA, 90024 USA,Brain Research Institute, David Geffen School of Medicine, Los Angeles, CA, 90024, USA
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Lee HMD, Bonnici K, Archer JRH, Dargan PI, Wood DM. From the internet to the hospital: current experiences of individuals presenting to the Emergency Department with acute recreational drug toxicity. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.980863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chesworth R, Brown RM, Kim JH, Lawrence AJ. The metabotropic glutamate 5 receptor modulates extinction and reinstatement of methamphetamine-seeking in mice. PLoS One 2013; 8:e68371. [PMID: 23861896 PMCID: PMC3701637 DOI: 10.1371/journal.pone.0068371] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/29/2013] [Indexed: 12/12/2022] Open
Abstract
Methamphetamine (METH) is a highly addictive psychostimulant with no therapeutics registered to assist addicts in discontinuing use. Glutamatergic dysfunction has been implicated in the development and maintenance of addiction. We sought to assess the involvement of the metabotropic glutamate 5 receptor (mGlu5) in behaviours relevant to METH addiction because this receptor has been implicated in the actions of other drugs of abuse, including alcohol, cocaine and opiates. mGlu5 knockout (KO) mice were tested in intravenous self-administration, conditioned place preference and locomotor sensitization. Self-administration of sucrose was used to assess the response of KO mice to a natural reward. Acquisition and maintenance of self-administration, as well as the motivation to self-administer METH was intact in mGlu5 KO mice. Importantly, mGlu5 KO mice required more extinction sessions to extinguish the operant response for METH, and exhibited an enhanced propensity to reinstate operant responding following exposure to drug-associated cues. This phenotype was not present when KO mice were tested in an equivalent paradigm assessing operant responding for sucrose. Development of conditioned place preference and locomotor sensitization were intact in KO mice; however, conditioned hyperactivity to the context previously paired with drug was elevated in KO mice. These data demonstrate a role for mGlu5 in the extinction and reinstatement of METH-seeking, and suggests a role for mGlu5 in regulating contextual salience.
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Affiliation(s)
- Rose Chesworth
- Behavioural Neuroscience Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Robyn M. Brown
- Behavioural Neuroscience Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Jee Hyun Kim
- Behavioural Neuroscience Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew J. Lawrence
- Behavioural Neuroscience Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
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Brecht ML, Lovinger K, Herbeck DM, Urada D. Patterns of treatment utilization and methamphetamine use during first 10 years after methamphetamine initiation. J Subst Abuse Treat 2013; 44:548-56. [PMID: 23313146 DOI: 10.1016/j.jsat.2012.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 12/05/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
The study examined joint trajectories of methamphetamine (MA) use and substance abuse treatment utilization and identified differences among pattern groups for a sample of 348 treated for MA use. Results from group-based trajectory modeling showed that treatment utilization during the first 10 years after initiation of MA use could be categorized into three distinctive patterns: about half the MA users have a pattern of low treatment utilization; one-fourth follow a quicker-to-treatment trajectory with higher probability of treatment during the first 5 years of MA use and less treatment in the next 5 years; and one-fourth have a slower-to-treatment trajectory with more treatment during the second half of the 10-year period. Four MA use patterns were identified: consistently low use, moderate, and high use, as well as a decreasing use pattern. Periods of greater likelihood of treatment participation were associated with periods of decreasing or lower frequency of MA use.
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Affiliation(s)
- Mary-Lynn Brecht
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90025, USA.
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Abstract
The objective of this study is to review and summarize available evidence regarding the impact of amphetamines on pregnancy, the newborn infant and the child. Amphetamines are neurostimulants and neurotoxins that are some of the most widely abused illicit drugs in the world. Users are at high risk of psychiatric co-morbidities, and evidence suggests that perinatal amphetamine exposure is associated with poor pregnancy outcomes, but data is confounded by other adverse factors associated with drug-dependency. Data sources are Government data, published articles, conference abstracts and book chapters. The global incidence of perinatal amphetamine exposure is most likely severely underestimated but acknowledged to be increasing rapidly, whereas exposure to other drugs, for example, heroin, is decreasing. Mothers known to be using amphetamines are at high risk of psychiatric co-morbidity and poorer obstetric outcomes, but their infants may escape detection, because the signs of withdrawal are usually less pronounced than opiate-exposed infants. There is little evidence of amphetamine-induced neurotoxicity and long-term neurodevelopmental impact, as data is scarce and difficult to extricate from the influence of other factors associated with children living in households where one or more parent uses drugs in terms of poverty and neglect. Perinatal amphetamine-exposure is an increasing worldwide concern, but robust research, especially for childhood outcomes, remains scarce. We suggest that exposed children may be at risk of ongoing developmental and behavioral impediment, and recommend that efforts be made to improve early detection of perinatal exposure and to increase provision of early-intervention services for affected children and their families.
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Lee N, Pennay A, Hester R, McKetin R, Nielsen S, Ferris J. A pilot randomised controlled trial of modafinil during acute methamphetamine withdrawal: feasibility, tolerability and clinical outcomes. Drug Alcohol Rev 2012; 32:88-95. [PMID: 22630616 DOI: 10.1111/j.1465-3362.2012.00473.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 05/03/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS There are no medications approved for the treatment of methamphetamine withdrawal. Wake-promoting agent modafinil has recently been proposed as a viable option. This paper reports on the results of a pilot study that tested the feasibility of modafinil in an inpatient withdrawal setting during acute methamphetamine withdrawal. DESIGN AND METHODS In a double-blind, randomised, placebo-controlled study, 19 methamphetamine dependent participants received modafinil (n = 9) or placebo (n = 10) daily for 7 days (200 mg for the first 5 days and 100 mg on days 6 and 7). Primary outcomes were retention in treatment and severity of withdrawal symptoms. Secondary outcomes were methamphetamine craving, sleep and physiological outcomes. RESULTS There were no significant differences between groups on retention in treatment, withdrawal severity, craving, sleep or physiological outcomes. There were no adverse events or side-effects reported. CONCLUSIONS Modafinil was found to be tolerable and well accepted by methamphetamine users and feasible for short-term inpatient withdrawal, but the sample was too small to detect treatment effects. Larger trials are needed to establish efficacy.
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Affiliation(s)
- Nicole Lee
- Turning Point Alcohol and Drug Centre, Melbourne, Australia
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Merrick EL, Reif S, Hiatt D, Hodgkin D, Horgan CM, Ritter G. Substance abuse treatment client experience in an employed population: results of a client survey. Subst Abuse Treat Prev Policy 2012; 7:4. [PMID: 22251622 PMCID: PMC3269994 DOI: 10.1186/1747-597x-7-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 01/17/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding client perspectives on treatment is increasingly recognized as key to improving care. Yet information on the perceptions and experiences of workers with private insurance coverage who receive help for substance use conditions is relatively sparse, particularly in managed behavioral health care organization (MBHO) populations. Furthermore, the role of several factors including prior service use has not been fully explored. METHODS Employees covered by a large MBHO who had received substance abuse services in the past year were surveyed (146 respondents completed the telephone survey and self-reported service use). RESULTS The most common reasons for entering treatment were problems with health; home, family or friends; or work. Prior treatment users reported more reasons for entering treatment and more substance use-related work impairment. The majority of all respondents felt treatment helped a lot or some. One quarter reported getting less treatment than they felt they needed. DISCUSSION AND CONCLUSIONS Study findings point to the need to tailor treatment for prior service users and to recognize the role of work in treatment entry and outcomes. Perceived access issues may be present even among insured clients already in treatment.
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Affiliation(s)
- Elizabeth L Merrick
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA 02454-9110, USA
| | - Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA 02454-9110, USA
| | - Deirdre Hiatt
- Health Net, 2370 Kerner Boulevard, Mail Stop: 909 02 05, San Rafael, CA 94901, USA
| | - Dominic Hodgkin
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA 02454-9110, USA
| | - Constance M Horgan
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA 02454-9110, USA
| | - Grant Ritter
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA 02454-9110, USA
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