Cultural Competence in the Treatment of Addictions: Theory, Practice and Evidence

Working effectively with individuals with substance use disorders: a qualitative descriptive study

BACKGROUND

Irrespective of where nurses work, they may provide care to individuals with substance use disorders. Unfortunately, some nurses may not understand how to work with these individuals and stigmatisation may occur.

AIM

To explore how to provide effective care for these individuals.

METHOD

A qualitative descriptive study examining helpful interventions for individuals with substance use disorders through interviewing four substance abuse specialist nurses.

FINDINGS

Findings consider person-centred care, such as how to create a therapeutic relationship with individuals with substance use disorders, empowerment of these individuals and providing hope, and employing a holistic approach.

CONCLUSION

Nurses may encounter individuals with substance use disorders and may benefit from knowledge of how best to intervene.

Patient centered medication treatment for opioid use disorder in rural Vermont: a qualitative study

BACKGROUND

Opioid-related fatal overdoses are occurring at historically high levels and increasing each year. Accessible social and financial support are imperative to the initiation and success of treatment for Opioid Use Disorder (OUD). Medications for Opioid Use Disorder (MOUD) offer effective treatment but there are many more people with untreated OUD than receiving evidence-based medication. Patient-centered care is associated with increased care utilization for substance use disorders. This qualitative study explored the patient perspective of OUD care through a Patient-Centered Care (PCC) framework to illuminate patients' sense of engagement in care.

METHODS

Fifteen semi-structured telephone interviews were conducted from August through November of 2021 regarding patient experiences receiving MOUD in 13 Vermont Hub and Spoke clinics. Emergent themes were deductively mapped to PCC domains of Therapeutic Alliance, Individualized Care, Shared Decision-Making, and Holistic Care.

RESULTS

Participants indicated that PCC fostered engagement and often characterized MOUD clinics they no longer attended as lacking in PCC. Themes related to Therapeutic Alliance were the most prevalent and suggest pathways to retention. Individualizing care through flexible appointment scheduling was strongly valued, while inflexible scheduling fostered fear of not getting medication. Some participants indicated they were less likely to remain in care when providers did not include them in decisions about medication type, dose, or formulation. Participants also appreciated holistic biopsychosocial care and care referrals.

CONCLUSIONS

Patient-centered MOUD care was important to participants and encouraged engagement in care. Prioritizing alliance with patients, adapting care to patient needs and preferences particularly when scheduling, including patients in medication decisions, and biopsychosocial attention to patients are congruent with patient perception of desirable MOUD care. Having this understanding of an established, leading MOUD treatment system may serve to benefit states looking to implement this model, or for states who are looking to improve the model they already have in place, potentially leading to higher treatment and retention rates.

TRIAL REGISTRATION

This was not a clinical trial involving an intervention, and therefore registration was not required.

Addressing Racial and Ethnic Inequities in Opioid Overdose Mortality: Strategies for Equitable Interventions and Structural Change

PURPOSE OF REVIEW

This review synthetizes findings reflecting the increasing racial and ethnic inequities in opioid overdose mortality and emphasizes the necessity for tailored interventions as well as other policy-level and structural strategies to stem this trend.

RECENT FINDINGS

Factors contributing to inequities in overdose mortality include changes in drug supply, persistent social-structural vulnerabilities stemming from structural racism, and inequities in access to medication for opioid use disorder and harm reduction services. Key strategies to address these inequities include the cultural adaptation of evidence-based interventions within an equity-based framework, integrating social determinants of health into addiction treatment, centering anti-racism praxis in addiction research, diversifying the addiction workforce, and integrating structural competency as a tool to restructure education and inform practice. Structural racism must be recognized as a key driver of inequities in substance use outcomes, and this understanding must be integrated into existing models of substance use disorder prevention, treatment, and research.

Preventive measures against HIV among Uganda's youth: Strategies, implementation, and effectiveness

Preventing HIV among Uganda's youth is a critical public health priority due to the high prevalence of HIV/AIDS and the disproportionate burden of new infections among young people. This paper examines the preventive measures implemented to combat HIV/AIDS among Uganda's youth, focusing on strategies, implementation efforts, and the effectiveness of interventions. Comprehensive sexuality education programs have been implemented in schools and communities to provide young people with accurate information on HIV transmission, prevention methods, and reproductive health. Condom distribution and promotion campaigns target sexually active youth, while HIV testing and counseling services aim to reach youth in various settings, including health facilities and community outreaches. The implementation of HIV prevention strategies involves collaboration among government agencies, NGOs, healthcare providers, educators, and community leaders. Efforts are made to ensure that prevention programs are culturally appropriate, evidence-based, and responsive to the needs of young people. Despite progress in HIV prevention, challenges persist, including knowledge gaps, stigma, gender inequalities, and socio-economic factors. Continuous monitoring and evaluation are essential to assess the impact of interventions and identify areas for improvement. Recommendations include increasing funding for HIV prevention programs, strengthening policy frameworks, enhancing access to youth-friendly health services, integrating comprehensive sexuality education into school curricula, and fostering community engagement. By addressing these recommendations, Uganda can strengthen its HIV prevention efforts and reduce the incidence of HIV/AIDS among its youth population, ultimately contributing to improved health outcomes and well-being.

Understanding cultural inclusion in alcohol and other drug services in New South Wales, Australia and assessing the acceptability of a cultural inclusion audit

INTRODUCTION

Cultural inclusion and competence are understood at the most basic level to be the practice of considering culture so as to provide effective services to people of different cultural backgrounds. In order to work better with clients from diverse backgrounds, alcohol and other drug (AOD) services need to offer a service that is designed to be accessible to all people, where systems in place operate in a way that considers different cultural needs. This research aimed to assess the extent to which non-government AOD services in New South Wales are positioned to support cultural inclusion as well as to evaluate the acceptability of a cultural inclusion audit across four AOD sites.

METHODS

The research adopted a mixed methods approach comprising of a pre-audit online survey (n = 85) designed to assess AOD services' attitudes and practices towards cultural inclusion, and in-depth interviews that were conducted with nine AOD service staff and four cultural auditors to explore the acceptability of a cultural inclusion audit process.

RESULTS

Findings from the survey indicate cultural inclusion practices are limited. Interview data highlight that while staff are not fully aware of what appropriate cultural inclusions entails, they are receptive to and want a cultural inclusion program.

DISCUSSION AND CONCLUSIONS

The study illustrates the benefits of implementing a cultural inclusion audit process aimed at raising awareness of what cultural inclusion entails. Including a cultural inclusion service audit is likely to enhance AOD service provision to culturally and linguistically diverse groups and thereby improve treatment outcomes.

Racial and ethnic disparities in receipt of specialty treatment across risk profiles of adults with heavy alcohol use

BACKGROUND

Variation in specialty treatment utilization for alcohol use disorder (AUD) by patient subgroups is poorly understood. This study examined whether and how patient risk profiles predict receipt of specialty treatment and whether there are disparities by race and ethnicity.

METHODS

This cohort study included 206,956 adults with heavy alcohol use (that which exceeded National Institute on Alcohol Abuse and Alcoholism guidelines) between June 1, 2013 and December 31, 2014, using electronic health record data from Kaiser Permanente Northern California. Five risk profiles (characterized by daily or weekly heavy drinking and level of health risks) were identified in latent class analysis. Logistic regression models were fit to examine associations between risk profiles, race, ethnicity, and receipt of specialty treatment (including addiction medicine, psychiatry, or integrated behavioral health visits, and AUD pharmacotherapy), adjusting for other patient characteristics. Variation in the association between risk profiles and receipt of specialty treatment by race/ethnicity was also examined.

RESULTS

Overall, 4.0% of patients received specialty treatment. Latino/Hispanic and Asian/Pacific Islander patients had lower odds of receiving specialty treatment than White patients (adjusted odds ratio [aOR] [95% CI] = 0.80 [0.75, 0.85], and 0.64 [0.59, 0.70], respectively). The substance use disorder and mental health disorder (SUD/MH) risk profile had the highest odds of receiving specialty treatment (10.46 [9.65, 11.34]). Associations between risk profiles and receipt of specialty treatment significantly differed by race/ethnicity. Black patients in the SUD/MH risk profile, and Hispanic/Latino patients in the risk profile with heavy daily drinking and more health risks, had lower odds of receiving specialty treatment than their White counterparts (adjusted ratio of odds ratios [aROR] [95% CI] = 0.69 [0.50, 0.94], and 0.79 [0.67, 0.92], respectively).

CONCLUSIONS

This study provides new insights into racial/ethnic disparities in specialty treatment utilization for alcohol problems. Findings may help inform strategies for tailoring interventions to address heavy alcohol use.

Latent Class Groups of Concurrent Substance Use Among Adolescents in an Urban Community: Correlates With Mental Health, Access to Drugs and Alcohol, and Risk Perception

BACKGROUND

Concurrent substance use among adolescents has been associated with an increase in physical and mental health problems. These outcomes tend to be exacerbated among adolescents of color in underserved urban settings. The purpose of this study was to understand alcohol and concurrent drug use patterns among adolescents in an underserved urban community to provide targeted prevention and treatment recommendations.

METHOD

This study examined data among adolescents in an underserved urban community (N = 1789; 56.90% female; 70.86% Hispanic/Latino/a; meanage = 15.96 ± 1.56). Using latent class analysis (LCA) and multinomial logistic regression modeling, analyses identified independent correlates of latent class membership.

RESULTS

Five latent classes (LC) were identified including LC group 1: Predominant alcohol use and limited to no concurrent-drug use (n = 213; 11.9%); LC group 2: Concurrent drug and alcohol use including methamphetamine, marijuana and synthetic marijuana use, and alcohol use (n = 74; 4.2%); LC group 3: Concurrent drug and alcohol use, with no marijuana use (n = 204; 11.39%); LC group 4: High Concurrent drug use and alcohol use (n = 204; 11.40%); and LC group 5: Concurrent drug use without alcohol use (n = 1101; 61.52%). Significant between group differences were noted between latent class groups and sociodemographic characteristics. Multinomial logistic regression models identified the associations between sociodemographic characteristics and corollary clinical features of substance use on latent class groupings of alcohol and concurrent drug use.

CONCLUSION

Understanding concurrent substance use LC groups among adolescents is essential to providing targeted interventions and treatment programs, as well as early intervention programs that may help reduce substance use during adolescence.

Risk profiles of adults with heavy alcohol use: Drinking patterns, behavioral and metabolic factors, health problems, and racial and ethnic disparities

BACKGROUND

Heavy alcohol use is a growing risk factor for chronic disease, yet little is known about its co-occurrence with other risk factors and health problems. This study aimed to identify risk profiles of adults with heavy alcohol use and examined potential disparities by race and ethnicity.

METHODS

This cross-sectional study included 211,333 adults with heavy alcohol use (in excess of daily or weekly limits recommended by National Institute on Alcohol Abuse and Alcoholism) between June 1, 2013 and December 31, 2014 in Kaiser Permanente Northern California. Latent class analysis was used to examine how heavy drinking patterns clustered with other behavioral and metabolic risk factors and health problems to form risk profiles. Multinomial logistic regression models were fit to examine associations between race, ethnicity, and risk profiles.

RESULTS

A 5-class model was selected as best fitting the data and representing clinically meaningful risk profiles: (1) "heavy daily drinking and lower health risks" (DAILY, 44.3%); (2) "substance use disorder and mental health disorder" (SUD/MH, 2.3%); (3) "heavy weekly drinking and lower health risks" (WEEKLY, 19.6%); (4) "heavy daily drinking and more health risks" (DAILY-R, 18.5%); (5) "heavy weekly drinking and more health risks" (WEEKLY-R, 15.3%). American Indian or Alaska Native (AIAN) and Black patients had higher odds than White patients of being in the SUD/MH, DAILY-R, and WEEKLY-R profiles than the DAILY profile. AIAN, Black, and Latino/Hispanic patients had higher odds than White patients of being in the SUD/MH, DAILY-R, and WEEKLY-R profiles rather than the WEEKLY profile.

CONCLUSIONS

AIAN, Black, and Latino/Hispanic patients with self-reported heavy drinking were more likely to be in risk profiles with greater alcohol consumption, more health risks, and higher morbidity. Targeted, culturally appropriate interventions for heavy alcohol use that may address other modifiable risk factors are needed to work towards health equity.

Exploring trends in benzodiazepine-positive fatal drug overdoses in Tennessee, 2019-2021

BACKGROUND

Benzodiazepine-positive overdoses increased between 2019 and 2021 in Tennessee. We sought to determine the changes in the number and characteristics of prescription and illicit benzodiazepine-positive fatal drug overdoses during this period.

MATERIALS AND METHODS

A statewide study was conducted to determine changes in the number and characteristics of benzodiazepine-positive drug overdose decedents using 2019-2021 data from the Tennessee State Unintentional Drug Overdose Reporting System. The analyses were limited to Tennessee residents aged ≥ 18 years. A benzodiazepine-positive overdose was defined as any benzodiazepine on toxicology, regardless of the presence of other substances. Frequencies were generated to compare demographics, circumstances, prescription history, and toxicology between 2019 and 2021 for illicit and prescription benzodiazepine-positive fatal overdoses.

RESULTS

Between 2019 and 2021, 1666 benzodiazepine-positive unintentional or undetermined fatal drug overdoses out of 5916 total overdoses that occurred among adult Tennessee residents with available toxicological information. Prescription benzodiazepines were identified in 80.7% of deaths, whereas illicit benzodiazepines were identified in 12.0% of deaths. Many decedents had an anxiety disorder (45.5%), while over half of all decedents had a history of substance use disorder (52.3%). Most benzodiazepine-positive overdoses involved fentanyl (71.3%).

CONCLUSIONS

This analysis can inform local and regional public health workers to implement focused prevention and intervention efforts for people with co-occurring mental health conditions and substance use disorders to curb overdose epidemics among persons using benzodiazepines in Tennessee. Public health campaigns should focus on educating people on appropriate prescription medication use and the dangers of obtaining substances illicitly. Given the high proportion of opioids in this population, further education also is needed on the dangers of polysubstance drug use. The differences between prescription and illicit benzodiazepine-positive fatal overdoses indicate the need to develop substance-specific prevention and treatment strategies.

Ethnicity as a risk factor for gambling disorder: a large-scale study linking data from the Norwegian patient registry with the Norwegian social insurance database

BACKGROUND

The study investigated ethnicity as a risk factor for gambling disorder (GD), controlling for demographics, citizenship, and years of residency in Norway.

METHODS

The sample comprised 65,771 individuals from a national patient registry (n = 35,607, age range 18-88 years) and a national social insurance database in Norway (n = 30,164, age rage 18-98 years). The data covered the period from 2008 to 2018.

RESULTS

The results showed that when controlling for age and sex, ethnic minorities were overall less likely than those born in Norway to be diagnosed with GD (odds ratio [OR] ranging from 0.293 to 0.698). After controlling for citizenship and years of residency in Norway, the results were reversed and indicated that ethnic minorities were overall more likely to be diagnosed with GD (OR ranging from 1.179 to 3.208).

CONCLUSION

The results suggest that citizenship and years of residency are important variables to account for when assessing the relationship between ethnicity and being diagnosed with GD. Our results may be explained by people from ethnic minority groups being more likely to experience gambling problems but less likely to seek contact with healthcare services for gambling problems.

Increasing overdose deaths among Black Americans: a review of the literature

In 2020, opioid overdose fatalities among Black Americans surpassed those among White Americans for the first time in US history. This Review analyses the academic literature on disparities in overdose deaths to highlight potential factors that could explain these increases in overdose deaths among Black Americans. Overall, we find that differences in structural and social determinants of health; inequality in the access, use, and continuity of substance use disorder and harm reduction services; variability in fentanyl exposure and risk; and changes in social and economic circumstances since the onset of the COVID-19 pandemic are central to explaining this trend. We conclude with a discussion of opportunities for US policy reform and opportunities for future research.

Deimplementation in the provision of opioid agonist treatment to achieve equity of care for people engaged in treatment: a qualitative study

BACKGROUND

Deimplementation, the removal or reduction of potentially hazardous approaches to care, is key to progressing social equity in health. While the benefits of opioid agonist treatment (OAT) are well-evidenced, wide variability in the provision of treatment attenuates positive outcomes. During the COVID-19 pandemic, OAT services deimplemented aspects of provision which had long been central to treatment in Australia; supervised dosing, urine drug screening, and frequent in-person attendance for review. This analysis explored how providers considered social inequity in health of patients in the deimplementation of restrictive OAT provision during the COVID-19 pandemic.

METHODS

Between August and December 2020, semi-structured interviews were conducted with 29 OAT providers in Australia. Codes relating to the social determinants of client retention in OAT were clustered according to how providers considered deimplementation in relation to social inequities. Normalisation Process Theory was then used to analyse the clusters in relation to how providers understood their work during the COVID-19 pandemic as responding to systemic issues that condition OAT access.

RESULTS

We explored four overarching themes based on constructs from Normalisation Process Theory: adaptive execution, cognitive participation, normative restructuring, and sustainment. Accounts of adaptive execution demonstrated tensions between providers' conceptions of equity and patient autonomy. Cognitive participation and normative restructuring were integral to the workability of rapid and drastic changes within the OAT services. Key transformative actors included communities of practice and "thought leaders" who had long supported deimplementation for more humane care. At this early stage of the pandemic, providers had already begun to consider how this period could inform sustainment of deimplementation. When considering a future, post-pandemic period, several providers expressed discomfort at operating with "evidence-enough" and called for narrowly defined types of data on adverse events (e.g. overdose) and expert consensus on takeaway doses.

CONCLUSIONS

The possibilities for achieving social equity in health are limited by the divergent treatment goals of providers and people receiving OAT. Sustained and equitable deimplementation of obtrusive aspects of OAT provision require co-created treatment goals, patient-centred monitoring and evaluation, and access to a supportive community of practice for providers.

Substance use and help-seeking barriers: a qualitative study of East African migrants' experiences of access to Norwegian healthcare services

BACKGROUND

Migration to Norway has increased rapidly in recent decades. Migrants have a lower prevalence of substance use, but may have an elevated risk of developing mental health issues and substance use problems due to various migration and post-migration factors. Few studies have sought to understand substance use problems among migrants in Norway. This study aimed to explore how people of East African background experience help-seeking for substance use problems in the Norwegian healthcare system.

METHODS

Using an explorative approach, in-depth individual interviews were conducted with six adult participants from Somalia, Eritrea and Sudan who had been in contact with the Norwegian healthcare system. The goal of the interviews was to facilitate in-depth and nuanced descriptions of the participants' lived experience of help-seeking for substance use problems. The data were analysed using interpretive phenomenological analysis.

RESULTS

The analysis resulted in five themes in which participants described their help-seeking experiences for substance use problems as lack of knowledge and access to information, scepticism towards a 'white system', fear of exclusion from family and ethnic community, racism as a barrier to help-seeking, and positive experiences and ideas for future treatment practices.

CONCLUSION

This study provides an improved understanding of how migrants with substance use problems experience help-seeking in healthcare. The variety of barriers illustrates inequality in substance use care for East African migrants in Norway.

Disparities in smoking prevalence and associations with mental health and substance use disorders in underserved communities across the United States

BACKGROUND

Smoking contributes to the top 3 deadliest cancers, cancers of the lung, colon, and pancreas, which account for nearly 40% of all cancer-related deaths in the United States. Despite historicly low smoking rates, substantial disparities remain among people with mental health conditions and substance use disorders (SUDs).

METHODS

The study examined the prevalence of smoking among adults from underserved communities who are served at federally qualified health centers through an analysis of the 2014 Health Center Patient Survey. Furthermore, the study assessed associations of smoking with co-occurring mental health conditions and SUDs among adult smokers (n = 1735).

RESULTS

The prevalence of smoking among health center patients was 28.1%. Among current smokers, 59.1% had depression and 45.4% had generalized anxiety. Non-Hispanic Black smokers had more than 2 times the odds of reporting SUDs (adjusted odds ratio [aOR], 2.13; 95% confidence interval [CI], 1.06-4.30). Individuals at or below 100% of the federal poverty level had more than 2 times the odds of having mental health conditions (aOR, 2.55; 95% CI, 1.58-4.11), and those who were unemployed had more than 3 times the odds for SUDs (aOR, 3.21; 95% CI, 1.27-8.10).

CONCLUSIONS

The prevalence of smoking in underserved communities is nearly double the national prevalence. In addition, the study underscores important socioeconomic determinants of health in smoking cessation behavior and the marked disparities among individuals with mental health conditions and SUDs. Finally, the findings illuminate the unique need for tailored treatments supporting cancer prevention care to address challenges confronted by vulnerable populations.

Recovery Capital among Migrants and Ethnic Minorities in Recovery from Problem Substance Use: An Analysis of Lived Experiences

Migrants and ethnic minorities (MEM) are known to be disadvantaged concerning risk factors for problem substance use and resources to initiate and sustain recovery (i.e., recovery capital). Yet, the voices of MEM are largely overlooked in recovery literature. This study explores recovery capital through 34 semi-structured interviews with a diverse sample of MEM in recovery in two ethnically diverse cities in Belgium. A Qualitative Content Analysis using recovery capital theory allowed us to identify various recovery resources on a personal, social, and community level. While physical and human recovery resources play a central role in participants' narratives, personal recovery capital is closely intertwined with meaningful social networks (i.e., social recovery capital) and recovery-supportive environments that maximize opportunities for building culturally sensitive recovery capital (i.e., community recovery capital). Though MEM-specific elements such as culture, migration background, stigma, and structural inequalities play a significant role in the recovery resources of MEM, the largely "universal" nature of recovery capital became clear. The narratives disclose a distinction between "essential" and "acquired" recovery capital, as well as the duality of some recovery resources. The need for developing recovery-oriented systems of care that are culturally responsive, diminish structural inequalities, and facilitate building recovery capital that is sensitive to the needs of MEM is emphasized.

The effects of drug addiction treatment methods on families' behaviors: The Congress 60 treatment method

BACKGROUND

When a family member who uses drugs begins drug abstinence, this change can cause a great deal of tension within a family. Although family members are willing to help drug users overcome their addiction, they sometimes disrupt the treatment process and, in many cases, resist change altogether.

METHOD

This qualitative research study uses grounded theory to study the factors that contribute to positive family change and changes in the family system throughout the treatment process. The study selected 39 participants from among the clients at Congress 60 Human Revivification Society using purposive sampling until the study reached data saturation. The study collected information from participants during semistructured interviews. The participants consisted of 18 men who used drugs and 21 individuals from their families who had undergone one year of treatment at Congress 60.

RESULTS & DISCUSSION

The findings of the current study show that peace in the family is an influential factor that helps drug users overcome their addiction. Clear boundaries, detachment, and reduced emotional distance were the major structural changes that participating families exhibited after educational interventions, positive family support, and they gained trust in the treatment method.

Genesis of change: Substance use treatment for forensic patients with mental health concerns

Substance use disorders are highly prevalent among forensic patients. They are associated with many challenges for patients with these problems, including their ability to rehabilitate and successfully move through secure forensic mental health services, as well as increasing risk for recidivism. Traditionally, forensic services have been more adept at focusing on and treating the primary mental health diagnosis alone and have been less likely to prioritise this co-occurring patient need. Opportunities exist to foster effective treatment strategies for substance use disorders, and past research has produced positive outcomes among forensic patients in studies in both Australia and the UK to navigate a new course for patients with these problems. By providing empirically validated, co-produced and culturally competent treatment responses, forensic patients living with substance use disorders will have the opportunity to significantly improve their wellbeing and progress through the system. They will also be more prepared and equipped to face challenges upon discharge into the community, including increased availability of alcohol and other drugs, social stigma and barriers to employment. Moreover, by prioritising effective substance use treatment programs during inpatient rehabilitation, services can reduce the levels of post-discharge recidivism.

Exploring the support for UK migrants experiencing gambling-related harm: insights from two focus groups

OBJECTIVES

To obtain insights about the accessibility of UK gambling support services from the perspectives of individuals and organisations supporting migrants experiencing gambling-related harm.

STUDY DESIGN

Two focus groups were conducted in Leeds and London, United Kingdom, in 2018.

METHODS

Thirty-two participants shared their views and experiences from their support work with migrant communities or support services and personal experiences. Thematic analysis identified four themes: (1) the relationship between gambling-related harm and migration, (2) the 'harm paradox' and migrant gambling, (3) barriers to help seeking and (4) ways to improve current support.

RESULTS

Participants considered that individuals' migration history may impact on their gambling participation. They considered that recent migrants experience similar gambling-related harms to the UK general population; however, their experience of harms may be exacerbated or accelerated by socio-economic circumstances. Concerns surrounding trust, confidentiality, social interaction, integration and language proficiency were interwoven with barriers that migrants may encounter when engaging in help-seeking behaviour. Participants called for better evidence and understanding of the culturally specific and contextual harms that migrants may experience from their gambling. They advocated a stronger emphasis on prevention and the development of culturally competent gambling support services.

CONCLUSIONS

Migrants are vulnerable to gambling-related harm; however, existing gambling support services may not meet their needs. Efforts should be made to ensure gambling support services are accessible to migrants and culturally sensitive. More research is needed to investigate gambling-related harm from the perspectives of migrants and to improve the promotion, design, delivery and accessibility of gambling support services for this population.

Gambling problems, risk factors, community knowledge, and impact in a US Lao immigrant and refugee community sample

OBJECTIVES

The objectives of this study were to examine gambling-related problems, risk factors, help-seeking attitudes, community perceptions, and correlates of problem gambling in a Lao sample of Southeast Asian refugees and immigrants and to discuss cultural implications for the treatment and prevention of gambling problems in Southeast Asian refugee and immigrant populations.

STUDY DESIGN

This was a cross-sectional, community-based interview study.

METHODS

Participants (N = 200, males = 51%, females = 49%) were recruited from a Lao community center in a major US metropolitan area (convenience sample; community center recruitment and peer nomination). Structured interviews on gambling and substance use were conducted by Lao center staff members in both English and Lao languages.

RESULTS

Gambling-related problems were measured using the South Oaks Gambling Screen (SOGS), gambling frequency, and quantity measures. In a previous study, we reported a substantial number of participants from the sample endorsed gambling-related harms and problems (SOGS score of five or more = 24%) and common methods of play were slots, house betting, cards at a casino, and sports betting. Among those endorsing five or more gambling problems, reasons for gambling included making money (68%), social life (31.3%), entertainment (58.3%), and reducing boredom (35.4%). Less commonly endorsed reasons were depression or stress (14.6%) and escape (10.4%). Many participants reported a family history of gambling problems. Those with problem gambling had twice the level of sibling problem gambling histories relative to those without problem gambling (35.4% vs. 11.1%). There were substantially more participants in the problem gambling group who had started gambling before the age of 13 years than in non-problem gamblers (P < .05). Many recognized gambling as a significant issue in the community and reported knowing several individuals affected by gambling-related problems.

CONCLUSIONS

Many participants recognized gambling as a significant issue in the Lao community. We include insights gleaned from a research partnership with a community organization. Although data cannot be generalized to the Lao community because of limitations in sampling methodology, participants viewed gambling as a culturally common social practice. Cultural norms affected where community members gamble, types of games, and betting practices. In this context, community members may view gambling-related harms as both a community-level and individual-level concern. These data suggest a significant need for rigorous research to inform policies and a culturally sensitive approach to public health prevention, intervention, and education. We discuss the challenges and cultural barriers to research and community engagement and offer suggestions for prevention and intervention ideas efforts.

Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review

BACKGROUND

Despite ongoing efforts aimed to improve treatment engagement for people with substance-related disorders, evidence shows modest rates of utilization as well as client-perceived barriers to care. Patient-centered care (PCC) is one widely recognized approach that has been recommended as an evidence-based practice to improve the quality of substance use disorder treatment. PCC includes four core principles: a holistic and individualized focus to care, shared decision-making and enhanced therapeutic alliance.

AIMS

This scoping review aimed to explore which PCC principles have been described and how they have defined and measured among people with substance-related disorders.

METHODS

Following the iterative stages of the Arksey and O'Malley scoping review methodology, empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references were eligible if they focused on people accessing treatment for substance-related disorders and described PCC. Two reviewers independently screened the title/abstract and full-texts of references. Descriptive analyses and a directed content analysis were performed on extracted data.

FINDINGS

One-hundred and forty-nine references met inclusion from the 2951 de-duplicated references screened. Therapeutic alliance was the most frequent principle of PCC described by references (72%); this was consistently defined by characteristics of empathy and non-judgment. Shared decision-making was identified in 36% of references and was primarily defined by client and provider strategies of negotiation in the treatment planning process. Individualized care was described by 30% of references and included individualized assessment and treatment delivery efforts. Holistic care was identified in 23% of references; it included an integrated delivery of substance use, health and psychosocial services via comprehensive care settings or coordination. Substance use and treatment engagement outcomes were most frequently described, regardless of PCC principle.

CONCLUSIONS

This review represents a necessary first step to explore how PCC has been defined and measured for people accessing substance use disorder treatment. The directed content analysis revealed population and context-specific evidence regarding the defining characteristics of PCC-principles that can be used to further support the implementation of PCC.

Group Psychotherapy in Specialty Clinics for Substance Use Disorder Treatment:The Challenge of Ethnoracially Diverse Clients

Minimal research has explored how clinicians address race and ethnicity considerations in the context of group psychotherapy within substance use disorder (SUD) specialty treatment settings. This article is an exploratory qualitative study in an effort to narrow this gap, using data from semi-structured interviews with 13 group clinicians at three outpatient SUD specialty clinics in the United States. Results are drawn from the portion of coded material pertaining to ethnoracial considerations. A predominant theme from the interviews was the importance of individualized care in terms of "meeting clients where they are at." However, minimal attention appears to have been given to addressing clients' demographic diversity. Overall, ethnoracial considerations were minimally addressed in groups, with clinicians framing such primarily in terms of "cultural" factors relevant to clinics' treatment philosophies. Moreover, limited attention was reportedly given to acknowledgment of social inequities faced by ethnoracial minority clients (e.g., racial discrimination), even though a few clinicians reported concern that minority clients were less engaged in treatment. Clinical implications of these findings and recommendations for future research are discussed.

Cultural competence in working with the Arab Australian community: a conceptual review and the experience of the Arab Council Australia (ACA) gambling help counselling service

Although Culturally And Linguistically Diverse (CALD) communities participate less in gambling than the general population, those who gamble are more likely to show signs of disordered gambling (Moore and Ohtsuka International Gambling Studies, 1, 87–101, 2001; Raylu and Oei Clinical Psychology Review, 23, 1087–1114, 2004; Yamine and Thomas The impact of gaming on specific cultural groups, Victorian Casino and Gaming Authority, Melbourne, 2000). Research data on gambling problems and interventions in the Arab Australian community are extremely scarce. Therefore, this article will present an overview of the Arab Australian community and cultural issues regarding gambling within the Arab Australian community. Identifying these issues is important to work effectively with Arab Australians clients and those from other CALD backgrounds. The article also presents a conceptual review of peer-reviewed research articles on cultural competence in working with the Arab clients, the overview of Arab migration history to Australia and a summary of recent events that suggest a tension between Arab and non-Arab Australian communities. Observations and experiences that were encountered during the gambling counselling service operating in the Australian Arab community in New South Wales are also discussed. The research data to validate the effectiveness and positive impact of cultural competence are still in its early stages. However, a small number of community education resources have been available for working with the Arab community. From the data in annual reviews on the Arab Council Australia gambling counselling service, it was identified that cultural beliefs and expectations influence risk-taking decisions, identification of gambling issues, and preference of help seeking within the client’s social network. Further, culturally-specific sensitive issues related to political and global security events, which in turn influenced openness and willingness for the help-seeking of the Arab Australians, were identified. In conclusion, we propose that recognising diversity within the Arab Australian community is a prerequisite for increasing cultural competence and cultural sensitivity for helping professionals working with Arab Australians.