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Fischer B, Robinson T, Jutras-Aswad D. Three noteworthy idiosyncrasies related to Canada's opioid-death crisis, and implications for public health-oriented interventions. Drug Alcohol Rev 2024; 43:562-566. [PMID: 38098180 DOI: 10.1111/dar.13796] [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: 08/13/2023] [Revised: 11/25/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
Canada has been experiencing a prolonged public health-crisis of high rates of overdose deaths caused by exceptionally potent/toxic, illicit opioid use. While many key features of this drug death epidemic are well-documented, several idiosyncratic aspects with relevance for public health-oriented interventions are not adequately recognised. These include: (i) the discrepant opioid patterns pan-Canada, with large majorities of opioid deaths caused by illicit fentanyl drugs in Western, but not Eastern regions where prescription-type opioid prevail; (ii) the environments of overdose deaths, where vast majorities occur in 'residential' or other shelter-type settings, presenting barriers for emergency interventions rather than health protection; and (iii) shifting drug use modes, where now majorities of overdose deaths are associated with drug 'inhalation' (instead of 'injection') in contexts of potent/toxic drug supply. We briefly describe these factors and related implications for intervention programming towards an improved response to the drug death-crisis.
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Affiliation(s)
- Benedikt Fischer
- Research & Graduate Studies, University of the Fraser Valley, Abbotsford, Canada
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Federal University of Sao Paulo, São Paulo, Brazil
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Tessa Robinson
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
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2
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Flannigan K, Murphy L, Pei J. Integrated Supports for Women and Girls Experiencing Substance Use and Complex Needs. Subst Abuse 2023; 17:11782218231208980. [PMID: 37954218 PMCID: PMC10637139 DOI: 10.1177/11782218231208980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023]
Abstract
There is strong research to support integrated and gender-sensitive harm reduction approaches for supporting women, girls, and gender diverse people. For individuals who are pregnant, flexible and integrated treatment approaches may be especially important. In this study, we report on an integrated program in rural Canada designed to support pregnant women, girls, and gender diverse people experiencing substance use and other complex needs. Program data (N = 393) from the 2nd Floor Women's Recovery Centre (2nd Floor) at the Lakeland Centre for Fetal Alcohol Spectrum Disorder (LCFASD) was analyzed with several aims. Study goals were to (1) describe characteristics and needs of clients, (2) identify factors associated with program completion, and (3) for a subset of clients, examine resources, wellbeing, and social and behavioral outcomes after treatment. Clients (Mage = 27.4 years, range 15-64) presented at the 2nd Floor with complex medical and mental health needs, and experiences of significant socioenvironmental adversity. However, almost two-thirds (63.4%) successfully completed the program, which was more likely for clients who had stable housing at intake and a possible or confirmed diagnosis of FASD. After treatment, clients reported high levels of wellbeing, and most were connected to health care and community resources. In the year after program completion, clients who were contacted for follow-up maintained strong connection to resources and reported notable improvements in social and behavioral functioning. Many were working or volunteering, most were in stable home environments, rates of substance use and legal involvement were substantially reduced, and many clients were actively caring for their children. This study offers important findings to inform future research, practice, and policy for supporting health and wellbeing for women, children, families, and communities.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Lisa Murphy
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
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3
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Mehtani NJ, Chuku CC, Meacham MC, Vittinghoff E, Dilworth SE, Riley ED. Housing Instability Associated with Return to Stimulant Use among Previously Abstaining Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6830. [PMID: 37835100 PMCID: PMC10572661 DOI: 10.3390/ijerph20196830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023]
Abstract
Stimulant use among unstably housed individuals is associated with increased risks of psychiatric co-morbidity, violence, HIV transmission, and overdose. Due to a lack of highly effective treatments, evidence-based policies targeting the prevention of stimulant use disorder are of critical importance. However, little empirical evidence exists on risks associated with initiating or returning to stimulant use among at-risk populations. In a longitudinal cohort of unstably housed women in San Francisco (2016-2019), self-reported data on stimulant use, housing status, and mental health were collected monthly for up to 6 months, and factors associated with initiating stimulants after a period of non-use were identified through logistic regression. Among 245 participants, 42 (17.1%) started using cocaine and 46 (18.8%) started using methamphetamine. In analyses adjusting for demographics and socio-structural exposures over the preceding month, experiencing street homelessness was associated with initiating cocaine use (AOR: 2.10; 95% CI: 1.04, 4.25) and sheltered homelessness with initiating methamphetamine use (AOR: 2.57; 95% CI: 1.37, 4.79). Other factors-including race, income, unmet subsistence needs, mental health, and treatment adherence-did not reach levels of significance, suggesting the paramount importance of policies directed toward improving access to permanent supportive housing to prevent stimulant use among unstably housed women.
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Affiliation(s)
- Nicky J. Mehtani
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA 94143, USA;
- Whole Person Integrated Care, San Francisco Department of Public Health, San Francisco, CA 94103, USA
| | - Chika C. Chuku
- Department of Public Health Sciences, University of Miami, Coral Gables, FL 33136, USA;
| | - Meredith C. Meacham
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA 94143, USA;
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA;
| | - Samantha E. Dilworth
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (S.E.D.)
| | - Elise D. Riley
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (S.E.D.)
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Wei X, Law YW. Quality of life of services users in psychotropic drug treatment and rehabilitation services: a qualitative study from service user and provider perspectives. SOCIAL WORK IN HEALTH CARE 2023; 62:321-344. [PMID: 37555388 DOI: 10.1080/00981389.2023.2238008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/11/2023] [Indexed: 08/10/2023]
Abstract
Quality of life (QoL) is a widely recognized and valuable social outcome measure in drug treatment and rehabilitation services, but the discrepancies in QoL perceptions between service users and providers remain under-explored. In this study, semi-structured interviews were conducted with service users (n = 22) and providers (n = 29) to capture their perceptions of QoL and explore the similarities and discrepancies between their views. A thematic analysis and contrast exploration revealed a shared understanding of QoL that extends beyond health to six dimensions and prioritizes empowerment and connection. However, divergent views emerged regarding the priorities of material conditions, emotional well-being, and physical health. Findings underscore the importance of using shared decision-making as a strategy to effectively address these discrepancies and promote a more patient-centered approach in treatment and rehabilitation services.
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Affiliation(s)
- Xinyi Wei
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Yik Wa Law
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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Lowenstein M, Abrams MP, Crowe M, Shimamoto K, Mazzella S, Botcheos D, Bertocchi J, Westfahl S, Chertok J, Garcia KP, Truchil R, Holliday-Davis M, Aronowitz S. "Come try it out. Get your foot in the door:" Exploring patient perspectives on low-barrier treatment for opioid use disorder. Drug Alcohol Depend 2023; 248:109915. [PMID: 37207615 DOI: 10.1016/j.drugalcdep.2023.109915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/15/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE Low-barrier treatment is an emerging strategy for opioid use disorder (OUD) care that prioritizes access to evidence-based medication while minimizing requirements that may limit treatment access in more traditional delivery models, particularly for marginalized patients. Our objective was to explore patient perspectives about low-barrier approaches, with a focus on understanding barriers to and facilitators of engagement from the patient point of view. METHODS We conducted semi-structured interviews with patients accessing buprenorphine treatment from a multi-site, low-barrier mobile treatment program in Philadelphia, PA from July-December 2021. We analyzed interview data using thematic content analysis and identified key themes. RESULTS The 36 participants were 58% male, 64% Black, 28% White, and 31% Latinx. 89% were enrolled in Medicaid, and 47% were unstably housed. Our analysis revealed three main facilitators of treatment in the low-barrier model. These included 1) program structure that met participant needs, such as flexibility, rapid medication access and robust case management services; 2) harm reduction approach that included acceptance of patient goals other than abstinence and provision of harm reduction services on-site; and 3) strong interpersonal connections with team members, including those with lived experience. Participants contrasted these experiences with other care they had received in the past. Barriers related to lack of structure, limitations of street-based care, and limited support for co-occurring needs, particularly mental health. CONCLUSIONS This study provides key patient perspectives on low-barrier approaches for OUD treatment. Our findings can inform future program design to increase treatment access and engagement for individuals poorly served by traditional delivery models.
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Affiliation(s)
- Margaret Lowenstein
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
| | - Matthew P Abrams
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Molly Crowe
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | | | - Denise Botcheos
- Prevention Point Philadelphia, Philadelphia, PA, United States
| | | | - Shawn Westfahl
- Prevention Point Philadelphia, Philadelphia, PA, United States
| | - Judy Chertok
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Kristine Pamela Garcia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Rachael Truchil
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - M Holliday-Davis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Shoshana Aronowitz
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States; University of Pennsylvania School of Nursing, Philadelphia, PA, United States
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Crowthers RA, Arya M, Venkataraman A, Lister JJ, Cooper SE, Enich M, Stevens S, Bender E, Sanders R, Stagliano K, Jermyn RT. Impact of an osteopathic peer recovery coaching model on treatment outcomes in high-risk men entering residential treatment for substance use disorders. J Osteopath Med 2022; 122:521-529. [PMID: 35802066 DOI: 10.1515/jom-2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/12/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT The United States has witnessed a disproportionate rise in substance use disorders (SUD) and co-occurring mental health disorders, paired with housing instability, especially among racially minoritized communities. Traditional in-patient residential treatment programs for SUD have proven inconsistent in their effectiveness in preventing relapse and maintaining attrition among these patient populations. There is evidence showing that peer recovery programs led by individuals who have lived experience with SUD can increase social support and foster intrinsic motivation within participants to bolster their recovery. These peer recovery programs, when coupled with a standardized training program for peer recovery coaches, may be very efficacious at improving patient health outcomes, boosting performance on Substance Abuse and Mental Health Services Administration (SAMHSA) national outcome measures (NOMs), and helping participants build an overall better quality of life. OBJECTIVES The goal of this study is to highlight the efficacy of a peer recovery program, the Minority Aids Initiative, in improving health outcomes and associated NOMs in men with SUD and/or co-occurring mental health disorder. METHODS Participants received six months of peer recovery coaching from trained staff. Sessions were guided by the Manual for Recovery Coaching and focused on 10 different domains of recovery. Participants and coaches set long-term goals and created weekly action plans to work toward them. Standardized assessments (SAMHSA's Government Performance and Results Act [GPRA] tool, Addiction Severity Index [ASI]) were administered by recovery coaches at intake and at the 6-month time point to evaluate participant progress. Analyses of participant recovery were carried out according to SAMHSA's six NOMs and assessed the outcomes of the intervention and their significance. RESULTS A total of 115 participants enrolled in the program over a 2-year period. Among them, 53 were eligible for 6-month follow-up interviews. In total, 321 sessions were held, with an average of three sessions per participant. Participants showed marked improvement across five of the six NOMs at the end of the 6-month course and across all ASI outcomes, with the exception of three in which participants reported an absence or few symptoms at intake. CONCLUSIONS Our study shows that participants receive benefits across nearly all NOM categories when paired with recovery coaches who are well trained in medication-assisted treatment (MAT) and medications for opioid use disorder (MOUD) over a 6-month period. We see the following: a higher rate of abstinence; increased housing stability; lower health, behavioral, and social consequences; lower depression and anxiety; longer participant-recovery coach exposure time; and higher follow-up rates. We hope that our results can contribute to advancements and greater acceptance in the implementation of peer recovery coaching as well as an improvement in the lives of the communities affected by substance use.
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Affiliation(s)
- Raymond A Crowthers
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Milan Arya
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Arvind Venkataraman
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Jamey J Lister
- Rutgers University School of Social Work, Center for Prevention Science, New Brunswick, NJ, USA
| | - Sarah E Cooper
- Rutgers University School of Social Work, Center for Prevention Science, New Brunswick, NJ, USA
| | - Michael Enich
- Rutgers University School of Social Work, Center for Prevention Science, New Brunswick, NJ, USA
| | - Scott Stevens
- Maryville Addiction Treatment Center, Williamstown, NJ, USA.,Maryville Addiction Treatment Center, Pemberton, NJ, USA
| | - Emily Bender
- Maryville Addiction Treatment Center, Williamstown, NJ, USA.,Maryville Addiction Treatment Center, Pemberton, NJ, USA
| | - Roynell Sanders
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Kenneth Stagliano
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Richard T Jermyn
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
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Stone J, Artenie A, Hickman M, Martin NK, Degenhardt L, Fraser H, Vickerman P. The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study. Lancet Public Health 2022; 7:e136-e145. [PMID: 35012711 PMCID: PMC8848679 DOI: 10.1016/s2468-2667(21)00258-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND A considerable proportion of people who inject drugs are unstably housed. Although unstable housing is associated with HIV and HCV infection among people who inject drugs, its contribution to transmission is unknown. We estimated the global and national proportions of incident HIV and HCV infections among people who inject drugs attributed to housing instability from 2020 to 2029. METHODS In this modelling study, we developed country-level models of unstable housing and HIV and HCV transmission among people who inject drugs in 58 countries globally, calibrated to country-specific data on the prevalences of HIV and HCV and unstable housing. Based on a recently published systematic review, unstably housed people who inject drugs were assumed to have a 39% (95% CI 6-84) increased risk of HIV transmission and a 64% (95% CI 43-89%) increased risk of HCV transmission. We used pooled country-level estimates from systematic reviews on HCV and HIV prevalence in people who inject drugs. Our models estimated the transmission population attributable fraction (tPAF) of unstable housing to HIV and HCV transmission among people who inject drugs, defined as the percentage of infections prevented from 2020 to 2029 if the additional risk due to unstable housing was removed. FINDINGS Our models were produced for 58 countries with sufficient data (accounting for >66% of the global people who inject drugs population). Globally, we project unstable housing contributes 7·9% (95% credibility interval [CrI] 2·3-15·7) of new HIV infections and 11·2% (7·7-15·5) of new HCV infections among people who inject drugs from 2020 to 2029. Country-level tPAFs were strongly associated with the prevalence of unstable housing. tPAFs were greater in high-income countries (HIV 17·2% [95% CrI 5·1-30·0]; HCV 19·4% [95% CrI 13·8-26·0]) than in low-income or middle-income countries (HIV 6·6% [95% CrI 1·8-13·1]; HCV 8·3% [95% CrI 5·5-11·7]). tPAFs for HIV and HCV were highest in Afghanistan, Czech Republic, India, USA, England, and Wales where unstable housing contributed more than 20% of new HIV and HCV infections. INTERPRETATION Unstable housing is an important modifiable risk factor for HIV and HCV transmission among people who inject drugs in many countries. The study emphasises the importance of implementing initiatives to mitigate these risks and reduce housing instability. FUNDING National Institute for Health Research and National Institute of Allergy and Infectious Diseases and National Institute for Drug Abuse.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Adelina Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Division of Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Petzold J, Rehmet L, Weber B, Spreer M, Krüger M, Zimmermann US, Pilhatsch M. Housing Correlates in Pregnant and Parenting Women Using Methamphetamine and Accessing Psychiatric Care. Front Psychiatry 2022; 13:890635. [PMID: 35711578 PMCID: PMC9196730 DOI: 10.3389/fpsyt.2022.890635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Integrated care is a promising model for pregnant and parenting women with problems related to methamphetamine use. Yet more research is imperative to guide services for this vulnerable population as methamphetamine use contributes to housing instability, which is associated with heavier use and overdose death. METHOD This prospective observational study analyzed how housing at discharge from psychiatric care was related to patient characteristics, program participation, and aftercare in 102 pregnant and/or parenting women. RESULTS Twelve of 23 women who were unstably housed at admission (three of six homeless) achieved stable housing by discharge from integrated care. Women were more likely unstably housed at discharge when unstably housed at admission, single, living apart from at least one minor, or when the other parent had a substance use disorder (p < 0.05). Unstably housed women at discharge were also more likely to have used social and inpatient services, and to transition to inpatient rehabilitation (p < 0.05). Among baseline characteristics, logistic regression identified unstable housing at admission (OR = 6.07) and being single (OR = 4.01) as the strongest unique contributors to unstable housing at discharge (p < 0.05). CONCLUSION Unstably housed women and single women seem particularly at risk of remaining in precarious living conditions despite accessing integrated care for problems associated with methamphetamine use. Future work should investigate whether stronger partnerships with government and community agencies could be a way forward to help these women attain and maintain stable housing.
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Affiliation(s)
- Johannes Petzold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Laura Rehmet
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Benjamin Weber
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Maik Spreer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Maria Krüger
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Ulrich S Zimmermann
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.,Department of Addiction Medicine and Psychotherapy, Kbo-Isar-Amper-Klinikum München-Ost, Haar, Germany
| | - Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Elblandklinikum Radebeul, Radebeul, Germany
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