Transformation of identity in substance use as a pathway to recovery and the potential of treatment for hepatitis C: a systematic review

BACKGROUND AND AIM

People who inject drugs are at high risk of contracting hepatitis C (HCV). The introduction of direct acting antiviral (DAA) drugs to treat HCV has the potential to transform care; however, uptake of DAAs has been slower than anticipated. The strong link between HCV and injecting drug use frames HCV as a shameful, stigmatising disease, reinforcing an 'addict' identity. Linking HCV care to a recovery journey, 'clean' identity and social redemption may provide compelling encouragement for people to engage with treatment and re-evaluate risk and behaviours, reducing the incidence of HCV re-infection. The aim of this review was to identify actions, interventions and treatments that provide an opportunity for a change in identity and support a recovery journey and the implications for HCV care.

METHODS

Databases (MEDLINE, EMBASE, PsycINFO, ProQuest Public Health, ProQuest Sociological Abstracts, CINAHL and Web of Science) were searched following our published strategy and a grey literature search conducted. A narrative synthesis was undertaken to collate themes and identify common threads and provide an explanation of the findings.

RESULTS

Thirty-two studies fulfilled the inclusion criteria. The narrative synthesis of the studies identified five over-arching analytical themes: social factors in substance use and recovery, therapeutic communities, community treatment, online communities, and finally women and youth subsets. The change from an 'addict' identity to a 'recovery' identity is described as a key aspect of a recovery journey, and this process can be supported through social support and turning point opportunities.

CONCLUSIONS

Recovery from addiction is a socially mediated process. Actions, interventions and treatments that support a recovery journey provide social connections, a recovery identity and citizenship (reclaiming a place in society). There is a gap in current literature describing how pathways of care with direct acting antivirals can be designed to promote recovery, as part of hepatitis C care.

The Influence of Risk and Protective Factors on Adolescent Alcohol, Cannabis, and Electronic Cigarette Use

The misuse of substances by adolescents is a serious public health concern in the United States, and the three most used substances by adolescents are alcohol, cannabis, and electronic cigarettes. In accordance with the Social Development Model, a better understanding of the risk and protective factors across these three substances can assist in predicting potential substance use as well as strategies for prevention. The purpose of the current study is to examine the similar or differential influence that a specific set of risk and protective factors (i.e., favorable attitudes toward substance use, perceived risk of harm, peer substance use, interaction with prosocial peers, parental favorable attitudes toward substance use, family management, perceived availability substances, and rewards for prosocial involvement) have on past 30-day alcohol, cannabis, and e-cigarette use by adolescents. The present study is based on a secondary data analysis of the 2019 Prevention Needs Assessment Survey, which is administered every two years in the State of Utah to a large sample of students in grades 6, 8, 10, and 12 grades. A subsample of students (n = 44,728) was included in the present analysis. Logistic regression was used to examine the predictive relation for the set of four risk and four protective factors on past 30-day use of alcohol, cannabis, and e-cigarette use. In general, the results indicated that endorsement of the four risk factors predicted increases in the use of each substance whereas endorsement of the four protective factors predicted decreases in use. Implications of these findings suggest that there may be more similarities in risk and protective factors across alcohol, cannabis, and electronic cigarettes than between them. In addition, this study adds to the budding literature on the risk and protective factors associated with adolescent e-cigarette use.

Transformation of identity in substance use as a pathway to recovery and the potential of treatment for hepatitis C: a systematic review protocol

INTRODUCTION

Hepatitis C virus (HCV) is a strongly stigmatised disease as it is framed within the context of injecting substance use. HCV provides the identity of 'dirty' or 'junky', with perceptions by others being beyond the control of the individual. People who experience problematic substance use are often viewed as being outside acceptable social behaviours, thus viewed as having tainted identities or second-class citizens. It is suggested that to recover from substance use, people should move towards social networks where substance use is not the norm and there is greater recovery support. The social identity model of recovery advocates that the mechanism to do this is by developing a new identity. It is unclear what catalysts provide this change in identity. This systematic review aims to describe actions, interventions and treatments that provide the opportunity for new identities and considers evidence that supports the hypothesis that curing HCV with direct acting antivirals may provide this opportunity.

METHODS AND ANALYSIS

Methods are informed by the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. Seven electronic peer-reviewed and four grey literature sources were identified and preliminary searches have been conducted. The inclusion and exclusion criteria are broad to capture activities that result in a change in identity, recovery from substance use, quality of life, life satisfaction or the opportunity for the individual to reclaim their place in society (citizenship). Qualitative and quantitative literature are eligible. Papers will be assessed against standardised criteria and checked independently and in duplicate. A narrative synthesis of the findings will be reported, structured around intervention type, population context and outcomes.

ETHICS AND DISSEMINATION

This systematic review will be based on studies that have already been conducted and therefore no ethical approvals are required. The resulting findings will be submitted to an international peer-reviewed journal and disseminated at relevant research conferences.

PROSPERO REGISTRATION NUMBER

CRD42020209447.

Perceptions of peer and parental attitudes toward substance use and actual adolescent substance use: The impact of adolescent-confidant relationships

Objective: While peer influence is a well-documented risk factor for adolescent substance use, it remains unclear whether peer or parental attitudes have greater impact, and if this relationship is moderated by having a confidant and the relationship between adolescents and their confidant. Method: Pooled (2015-2018) National Survey on Drug Use and Health (NSDUH) data on adolescents (12-17 years) were used. Perceived peer and parental disapproval of tobacco, alcohol, and marijuana use were dichotomized. We assessed associations between disapproval and past-month tobacco (N = 51,352), alcohol (N = 51,407), and marijuana use (N = 51,355) using separate multivariable logistic regression models. We explored effect modification by the presence of a confidant, parental vs. non-parental disapproval, and peer vs. non-peer confidant relationship. Results: Peer and parental disapproval, presence of any confidant, and identifying a parental confidant were consistently protective against substance use; identifying a peer confidant increased odds of use across substances. For marijuana use, peer disapproval (adjusted odds ratio [aOR]: 0.07, 95% confidence interval [CI]: 0.06, 0.08) was more protective than parental disapproval (aOR: 0.13, 95% CI: 0.12, 0.15). The joint presence of peer/parental disapproval and any confidant decreased the odds of substance use beyond the individual effects of peer/parental disapproval and having a confidant. However, having a peer confidant attenuated the protective association between peer/parental disapproval and tobacco, alcohol, and marijuana use. Conclusions: Both peer and parental relationships are salient when considering the social context of adolescent substance use and should be considered when studying the effects of perceived disapproval.

A qualitative study to understand drivers of psychoactive substance use among Nepalese youth

Background

Psychoactive substance use among youth is an emerging public health issue in Nepal. This exploratory study aimed to better understand the drivers of psychoactive substance use among Nepalese youth in Rupandehi district of Nepal.

Materials and methods

This study used a qualitative approach for data collection. Both in-depth interviews (IDI, seven participants) and focus group discussions (FGD, 13 participants) were conducted among study participants who self-reported as psychoactive substance users or had history of psychoactive substance use. Participants for IDI were aged between 11 and 24 years and between 18 and 35 years old for FGDs. Semi-structured interview guides were prepared separately for IDIs and FDGs. Interviews were conducted in Nepali language and were audio recorded, which were there transcribed and translated into English for coding and analyses. In addition, interviews notes were taken by two research assistants. An inductive thematic analysis was used to analyze the data.

Results

This study identified a range of drivers of psychoactive substances use among Nepalese youths. Themes included (i) socio-cultural factors, (ii) individual factors, (iii) academic environment, (iv) physical environment and the (v) influence of media. The socio-cultural factors were categorized into sub-themes of family relationships, ethnic identity and psychoactive substance use and lack of social acceptance. Individual factors included peer pressure, stress relief and coping with financial challenges. Accessibility and availability of psychoactive substances in the surrounding environment and lack of monitoring and reinforcement of rules/ law and regulations were other drivers to psychoactive substance use among this Nepalese youth cohort.

Conclusion

Our study identified several important drivers of psychoactive substance use among youth in the Rupandehi district of Nepal. Future works are anticipated to further explore youth initiation and use of psychoactive substances and support the design of interventions that address these risk factors to reduce and prevent subsequent harms.

Identifying the Hidden Population: Former Intravenous Drug Users Who Are No Longer in Contact with Services. "Ask a Friend"

People who, after a period of drug use, have changed their lifestyle and left substance use behind them are a hidden population within our communities. Lack of contact with drug services may mean that they are not tested for hepatitis C (HCV) infection through service-led initiatives and, therefore, may be exposed to the chronic morbidity and risk of death inherent with a legacy of HCV infection. This study utilized respondent-driven sampling (RDS) in a novel fashion to find those at historical risk of HCV. The social networks of people with a history of drug use were mapped, and individuals not currently in contact with services were invited to come forward for testing by members of their social network. The study used a reference group to inform study methodology and communication methods to reach out to this hidden population. One hundred and nine individuals received dry blood spot tests for HCV, 17.4% were antibody positive. Fifty one individuals met the inclusion criteria for this study. One hundred and twenty three invite-to-test coupons were issued; however, only one wave of recruitment consisting of one participant resulted from this method. Using RDS in historical social networks was not effective in this study and did not reach this hidden population and increase testing for HCV. This study is registered with clinicaltrials.gov (Ref NCT03697135).

An Ethnographic Look into Farmer Discussion Groups through the Lens of Social Learning Theory

Farmer discussion groups (FDGs) are a collaborative mechanism through which farmers can engage and learn from and with their peers. Participants cite numerous benefits from FDGs, e.g., economic, social, etc., but how learning happens in these contexts from an adult cognitive learning theory perspective is not well understood. Thus, Bandura’s social learning theory was used to study seven FDGs in the South West of England. The objective was to determine whether social learning was occurring through the FDGs’ interactions, examined according to three elements: (1) behaviour modelling, (2) role modelling and (3) self-reflexivity. An ethnographic methodology was utilised to gather rich empirical data through participant observation of 42 meetings and 24 semi-structured interviews. The results from 12 months attending FDG meetings demonstrated that behaviour modelling and role modelling were present in all FDGs. Self-reflexivity, however, was not evidenced as being promoted by all groups’ interactions, which (facilitated) critical discourse amongst the FDG participants was found to foster. Thus, evidence of social learning was not found to be occurring as a result of all the FDGs’ interactions. Collaborative learning processes that aim to promote social learning should build participants’ capacity and skills, structure engagement and train facilitators to foster critical discourse that may help promote self-reflexivity from behaviour modelling and role modelling.