Possible barriers to enrollment in substance abuse treatment among a diverse sample of Asian Americans and Pacific Islanders: opinions of treatment clients

Self-stigma and treatment motivation in inpatient with substance use disorders: Westside of Turkey

The aim of the study was to determine the relationship between self-stigma and treatment motivation among individuals with substance use disorders in Westside of Turkey. Descriptive cross-sectional design study's sample consisted of 141 patients with substance use disorder receiving treatment in an alcohol and drug treatment unit in Westside of Turkey. Data were collected using the Treatment Motivation Questionnaire (TMQ) and the Substance Abuse Self-Stigma Scale (SASSS). Self-stigma was positively correlated with internal motivation, external motivation, interpersonal help-seeking and treatment motivation (p < 0.001). Self-stigma was negatively correlated with confidence in treatment (p < 0.05). The simple linear regression analysis showed a significant relationship between treatment adherence and self-stigma (R:0.98, R2: 0.96, p < 0.001).

Increasing the visibility of Asian American, Native Hawaiian, and Pacific Islanders in substance use research: A call to action

Asian Americans, Native Hawaiians, and Pacific Islanders (AA/NH/PI) are one of the most diverse racial and ethnic groups in the U.S., encompassing origins from over forty countries. Historical biases stereotyping AA/NH/PI as "model minorities" compounded with familial norms of privacy regarding mental health in these communities has reduced the presence of AA/NH/PI in substance use treatment and research. This has led many individuals in U.S. society to inaccurately construe that AA/NH/PI lack mental health difficulties. In addition, although the term AA/NH/PI was developed to increase within-group solidarity and cohesion, the reductionism of categorizing AA/NH/PI into a single racial/ethnic group obscures the corresponding subjectivities of distinct AA/NH/PI subgroups. Such reductionism overshadows the underrepresentation of specific AA/NH/PI subgroups in substance use research, practice, and as investigators and students in the field. In this commentary, we, a group of AA substance use investigators, examine extant research on AA/NH/PI substance use and call to attention the underrepresentation of AA/NH/PI in the field of substance use: (1) as a diverse community understudied; (2) as investigators underfunded; (3) and as students under-supported. AA/NH/PI may be one of the fastest growing racial/ethnic groups in the United States, but because of structural inequities which forego seeing some AA/NH/PI as having minoritized identities, we have become invisible.

Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review

The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.

Substance use and treatment disparities among Asian Americans, Native Hawaiians, and Pacific Islanders: A systematic review

BACKGROUND

The increasing relevance of substance use disorder (SUD) within the Asian American, Native Hawaiian, and Pacific Islander (AA&NH/PI) communities, particularly amidst rising anti-Asian hate incidents and the disproportionate health and economic challenges faced by the NH/PI community during the COVID-19 pandemic, underscores the urgency of understanding substance use patterns, treatment disparities, and outcomes.

METHODS

Following PRISMA guidelines, 37 out of 231 studies met the search criteria. Study characteristics, study datasets, substance use rates, SUD rates, treatment disparities, treatment quality, completion rates, and analyses disaggregated by the most specific AA&NH/PI ethnic group reported were examined.

RESULTS

Despite increased treatment admissions over the past two decades, AA&NH/PI remain underrepresented in treatment facilities and underutilize SUD care services. Treatment quality and completion rates are also lower among AA&NH/PI. Analyses that did not disaggregate AA and NHPI as distinct groups from each other or that presented aggregate data only within AA or NHPI as a whole were common, but available disaggregated analyses reveal variations in substance use and treatment disparities among ethnic groups. There is also a lack of research in exploring within-group disparities, including specific case of older adults and substance use.

CONCLUSION

To address disparities in access to substance use treatment and improve outcomes for AA&NH/PI populations, targeted interventions and strategic data collection methods that capture diverse ethnic groups and languages are crucial. Acknowledging data bias and expanding data collection to encompass multiple languages are essential for fostering a more inclusive approach to addressing SUD among AA&NH/PI populations.

The relationship between reincarceration and treatment of opioid use disorder with extended-release naltrexone among persons with HIV

Background

In the United States, a disproportionate number of persons with HIV (PWH) and opioid use disorder (OUD) are involved in the justice system. Medications for OUD (MOUD) can reduce convictions and incarceration time in persons with OUD. Extended-release naltrexone (XR-NTX) has been shown to reduce craving of opioids, recurrence of use, and overdose and help achieve or maintain HIV viral suppression in PWH with OUD involved with the justice system.

Objectives

This retrospective study aimed to describe factors associated with reincarceration and to evaluate if XR-NTX was associated with reduced reincarceration among PWH and OUD who were released to the community from incarceration.

Methods

Data from participants released to the community from incarceration from a completed randomized controlled trial was analyzed using a generalized linear model to estimate odds ratios associated with reincarceration and a Kaplan-Meier survival analysis to determine time to reincarceration and non-reincarcerated individuals were compared.

Results

Of the 77 participants, 41 (53.2%) were reincarcerated during the 12-month study period. The mean time to reincarceration was 190 days (SD=108.3). Compared with participants who remained in the community, reincarcerated participants were more likely to have major depressive disorder at study baseline, increased opioid cravings, longer mean lifetime incarceration, and a higher physical quality of life score. XR-NTX was not significantly associated statistically with reincarceration in this analysis.

Conclusion

Reducing reincarceration is a public health priority, given the high proportion of PWH and OUD in the U.S. justice system as well as high degrees of persons returning to the community and having care interrupted due to reincarceration. This analysis determined that potentially identifying depression in recently released individuals could improve HIV outcomes, decrease recurrence of opioid use, and reduce reincarceration.

Native Hawaiian/Pacific Islander alcohol, tobacco and other drug use, mental health and treatment need in the United States during COVID-19

INTRODUCTION

Before COVID-19, Native Hawaiians/Pacific Islanders (NH/PI) endured a heavy burden of alcohol, tobacco and other drug (ATOD) use in prior US data. Responding to reports that many NH/PI communities experienced severe COVID-19 disparities that could exacerbate their ATOD burden, we partnered with NH/PI communities to assess the substance use patterns and treatment needs of diverse NH/PIs during COVID-19.

METHODS

Collaborating with NH/PI community organisations across five states with large NH/PI populations, we conducted a large-scale investigation of NH/PI ATOD use, mental health and treatment need during COVID-19. Between April and November 2021, NH/PI-heritage research staff from our community partners collected data involving 306 NH/PI adults using several community-based recruitment methods (e-mail, telephone, in-person) and two survey approaches: online and paper-and-pencil. Multivariate regressions were conducted to examine potential predictors of NH/PI alcohol use disorder and need for behavioural health treatment.

RESULTS

During COVID-19, 47% and 22% of NH/PI adults reported current alcohol and cigarette use, while 35% reported lifetime illicit substance use (e.g., cannabis, opioid). Depression and anxiety were high, and alcohol use disorder, major depression and generalised anxiety disorder prevalence were 27%, 27% and 19%, respectively. One-third of participants reported past-year treatment need with lifetime illicit substance use, COVID-19 distress and major depression respectively associating with 3.0, 1.2, and 5.3 times greater adjusted odds for needing treatment.

CONCLUSIONS

NH/PI adults reported heavy ATOD use, depression, anxiety and treatment need during COVID-19. Targeted research and treatment services may be warranted to mitigate COVID-19's negative behavioural health impact on NH/PI communities.

Health literacy and healthcare service utilisation in the 12-months prior to entry into residential alcohol and other drug treatment

INTRODUCTION

Health literacy refers to an individual's capacity to gather, process and understand health information, make appropriate health decisions, and engage adequately with healthcare services. Inadequate health literacy has been linked to an increase in acute healthcare utilisation. Research suggests that people living with substance use disorders also access acute healthcare services at high rates. The study investigates whether overall health literacy is related to this population's use of general healthcare services.

METHODS

A total of 568 participants were recruited from residential substance use treatment services located in NSW, Australia, as part of a randomised controlled trial; the Continuing Care Project. All participants completed a face-to face baseline questionnaire, which included the Health Literacy Questionnaire; a measure of multidimensional health literacy. Latent profile analysis was used to examine health literacy profiles, with multinominal regression analysis examining if healthcare service utilisation was related to these profiles.

RESULTS

Three profiles of health literacy were identified and termed lowest (n = 86, 15.1%), moderate (n = 338, 59.5%) and highest health literacy (n = 144, 25.4%). The sample accessed both primary and acute healthcare services at high rates. When controlling for demographic variables, there were no significant differences identified between health literacy profiles and service use.

DISCUSSION/CONCLUSIONS

This study was the first to use a multidimensional health literacy tool to examine health literacy and general healthcare service utilisation for people attending residential substance use disorder treatment. This population access high levels of healthcare services, however the role that health literacy may play in helping reduce acute healthcare use requires further investigation.

Debunking the myth of low behavioral risk among Asian Americans: The case of alcohol use

BACKGROUND AND PURPOSE

Asian Americans (AAs) are the fastest-growing ethnic group in the United States. There is a paucity of research on alcohol-related problems among AAs. However, alcohol use and misuse are a growing concern within this population and are associated with adverse health and mental health consequences.

METHODS

Using data from the 2015-2018 National Survey on Drug Use and Health (NSDUH), we examined the prevalence, psycho-social-behavioral correlates, and gender differences in drinking, binge drinking, and alcohol use disorder (AUD) among AA adolescents and adults. We also estimated the prevalence of binge drinking and AUD by country of origin and nativity.

RESULTS

Older adolescents (15-17) had the highest prevalence of past-month drinking (8.00%), binge drinking (4.3%), and AUD (1.8%). Among AA adults, the highest rates of binge drinking (23.0%) and AUD (7.2%) were observed among young adults ages 18-25. The highest rates of binge drinking and AUD were observed among US-born Korean Americans (binge drinking: 26.9%, AUD: 13.1%) and US-born Filipino Americans (binge drinking: 25.9%, AUD: 6.2%).

CONCLUSIONS

Contrary to the common perception that AA is a low-risk group for alcohol problems, we found that AA young adults, US-born Korean, Filipino, and Indian Americans have a high risk for drinking, binge drinking, and/or AUD. We also identified risk and protective factors against alcohol use/misuse among AAs. Preventions and interventions that incorporate the important risk/protective factors for AAs using a culturally sensitive approach are needed.

Comorbid Substance Use Disorder Profiles and Receipt of Substance Use Disorder Treatment Services: A National Study

OBJECTIVE

Those with comorbid substance use disorders (SUDs) are a particularly vulnerable group. Information regarding the nature of these comorbidities and how they relate to receipt of substance use treatment could reduce the treatment gap that exists among those with comorbid SUDs.

METHOD

Public-use data from the 2015-2017 National Surveys on Drug Use and Health was used to analyze past-year SUD comorbidity combinations among 12 substances and the relationship between these combinations with past-year treatment in adults (N = 128,740).

RESULTS

In all, 7.9% of adults had at least one SUD in the past year (6.7% had one SUD, 0.9% had two SUDs, and 0.3% had three or more). Conditioning on specific SUDs, the prevalence of having additional SUDs ranged from 14.9% (alcohol) to 85.1% (hallucinogens). The four most common SUD combinations all included alcohol use disorder. Alcohol and marijuana use disorder was the most common comorbidity combination and had the lowest receipt of treatment. Compared to those with one SUD, adjusted odds of receiving treatment were almost two times greater for those with two SUDs, and more than four times greater for those with three or more SUDs. Treatment prevalence was lower for those who had higher family income and education, were not employed full time, were married, were younger than age 26 years or older than age 50 years, and were Asian.

CONCLUSIONS

Even though the treatment gap is reduced among those with multiple SUDs, it remains large. The most common and undertreated comorbid SUD combinations, in conjunction with the most underserved groups, could be targeted to facilitate treatment uptake.

State population indices predict Asian American and Pacific Islander successful substance use treatment completion: An exploratory observational study

Cultural capital is a known factor supporting success in substance use disorder (SUD) treatment. We investigated Asian American and Pacific Islander (AAPI) State population metrics in relation to SUD treatment completion for US clients from 2006-2017 (N = 5,404,374). Metrics that may signify greater available cultural capital were State AAPI Percentage, State AAPI Percent Change, and State AAPI Population. AAPI Percentage, AAPI Percent Change were positively associated, while AAPI Population was negatively associated with treatment completion (p < 0.001). Findings suggest treatment agencies in areas with low AAPI densities may improve outcomes by supporting AAPI community and cultural social networks.

Treatment Experiences with Norwegian Health Care among Immigrant Men Living with Co-Occurring Substance Use- and Mental Health Disorders

Immigrants are considered at risk of psychological distress and therefore involvement in substance abuse, due to a variety of pre- and post-migration factors. Further, there is lower treatment engagement, a higher dropout rate, and less frequent hospitalizations among this group compared to the general population. There are few studies on the subjective understanding of co-occurring substance use disorder (SUD) and mental health disorder (MHD) among immigrants in Norway. This qualitative study aims to explore the treatment experiences of immigrant men living with co-occurring SUD and MHD. Within a collaborative approach, individual interviews were conducted with 10 men of immigrant background, living with co-occurring SUD and MHD, who had treatment experiences from the Norwegian mental health and addiction services. Data were analyzed using a systematic text condensation. The analysis yielded 6 categories where participants described their treatment experiences in mental health and addiction services in Norway as: lack of connection, lack of individually tailored treatment, stigma and discrimination preventing access to treatment, health professionals with multi-cultural competence, care during and after treatment, and raising awareness and reducing stigma. A significant finding was the mention by participants of the value of being seen and treated as a “person” rather than their diagnosis, which may increase treatment engagement. They further mentioned aftercare as an important factor to prevent relapse. This study provides an enhanced understanding of how immigrant men living with co-occurring SUD and MHD experienced being treated in Norwegian healthcare settings. These experiences may add to the knowledge required to improve treatment engagement.

Achieving Mental Health Equity: Addictions

Despite available treatment options for addiction, there remains an abysmal uptake of treatment initiation and engagement among varying communities. The existing treatment gap is based on historical occurrences, including discriminatory drug policies that have targeted communities of color with addiction. The current opioid epidemic and differential treatment therein exemplifies the severity of the existing disparity in addiction treatment, highlighting barriers such as institutionalized racism and vulnerabilities in the social determinants of health. To mitigate the disparity, an array of solutions to address these inequities are discussed, thereby providing a pathway forward to eliminating this treatment gap.

Determinants and Prevention Strategies of Substance Abuse in Pacific Countries: A Systematic Review

OBJECTIVES

People abuse substances like drugs, alcohol, and tobacco for different reasons, including pleasure, improved performance and vigilance, relief of depression, curbing hunger, and weight control. In this review, we sought to identify the determinants and prevention strategies that have been undertaken to minimize the issue of substance abuse.

METHODS

The systematic review was conducted following the Cochrane Library Guidelines and PRISMA checklist. We searched six online databases to identify studies from January 2000 to July 2017.

RESULTS

Only peer-reviewed studies published in the English language that had full text accessible were included. We reviewed 19 studies; only one was quasi-experimental and the majority were descriptive studies. The determinants of substance abuse identified include personal, faciliatory/promotor, environmental, and social factors. The prevention strategies identified use culturally appropriate and gender-sensitive treatments, and identify sources of strength in families, community, individual, and even spiritual.

CONCLUSIONS

Substance abuse poses significant public health risks and therefore requires adequate interventions such as educating and informing individuals of the health risks associated with substance abuse and must be considered locally to promote the well-being of people.

Hazardous drinking, alcohol use disorders, and need for treatment among Pacific Islander young adults

Pacific Islander (PI) young adults are suspected to bear heavy risk for hazardous drinking, alcohol use disorders (AUD), and alcohol-related harms. Yet, PIs remain among the most understudied racial groups in the United States-creating a lack of empirical data documenting their alcohol use problems and treatment needs. The present study presents the first known data on PI young adults' hazardous drinking, possible AUDs, alcohol-related harms, and treatment needs. Survey data were collected from 156 community-dwelling PI young adults (40% women, age 18-30 years) in 2 large PI communities: Los Angeles County and Northwest Arkansas. We screened participants for alcohol, cigarette, and marijuana use, hazardous drinking, possible AUD, alcohol-related harms, and past-year need for mental health and substance use disorder (SUD) treatment. Logistic regressions examined whether experiencing possible AUD and alcohol-related harms were associated with past-year need for treatment. PI young adults reported 78% lifetime rate of alcohol use with 56% screening positive for hazardous drinking, 49% for any possible AUD, and 40% experiencing significant alcohol-related harm (e.g., health, finances). Yet, just 25% of participants reported past-year need for SUD treatment. Although having possible AUD was not associated with perceived SUD treatment need, experiencing any alcohol-related harm associated with 4.7-13.2 times greater adjusted odds for needing treatment. Therefore, despite having low self-perceived treatment need, PI young adults experience excessive burden of hazardous drinking and alcohol-related harms. Given the profound negative social and health effects of AUDs, culturally grounded interventions should be designed to reduce PI young adults' elevated rates of hazardous drinking and alcohol-related harms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Factors Contributing to Substance Misuse Treatment Completion among Native Hawaiians, Other Pacific Islanders, and Asian Americans

Background: Research on substance abuse treatment completion (SATC) among Asian Americans and Native Hawaiian and Other Pacific Islanders (NHOPIs) is extremely limited despite growing concern of SA among these groups. Objectives: This study examined predictors of SATC among and within Asian, NHOPI, and White racial groups. Methods: 129,939 cases from the SA and Mental Health Services, Treatment Episode Data Set-Discharges-2016 were used in this study. Logistic regressions were employed to examine the differential impact of race on SATC and to investigate the moderating effect of race on the relationship between socioeconomic factors, type of substance used, and type of treatment setting on SATC. Results: NHOPIs were less likely to complete SA treatment than Whites. Within-group analysis indicated that NHOPIs who were in outpatient non-intensive treatment were more likely to complete treatment compared to ones in inpatient (more than 30 days), and outpatient intensive settings. In contrast, Asians and Whites in outpatient non-intensive treatment settings were less likely to complete compared to all other types of treatment settings. Older adults for Whites were more likely to complete treatment compared with younger adults. Age was not a significant predictor of SATC for Asians and NHOPIs. Asian and NHOPI methamphetamine users were less likely to complete treatment compared with White users. Conclusion/Importance: Findings highlight the importance of disaggregating Asians and NHOPIs in future SA studies to better understand how specific factors are relevant to each group, and to guide the development of cultural and race-informed treatments for these groups.

Impact Of Medicaid Expansion On Coverage And Treatment Of Low-Income Adults With Substance Use Disorders

Extensive undertreatment of substance use disorders has focused attention on whether the expansion of eligibility for Medicaid under the Affordable Care Act (ACA) has promoted increased coverage and treatment of these disorders. We assessed changes in coverage and substance use disorder treatment among low-income adults with the disorders following the 2014 ACA Medicaid expansion, using data for 2008-15 from the National Survey on Drug Use and Health. The percentage of low-income expansion state residents with substance use disorders who were uninsured decreased from 34.4 percent in 2012-13 to 20.4 percent in 2014-15, while the corresponding decrease among residents of nonexpansion states was from 45.2 percent to 38.6 percent. However, there was no corresponding increase in overall substance use disorder treatment in either expansion or nonexpansion states. The differential increase in insurance coverage suggests that Medicaid expansion contributed to insurance gains, but corresponding treatment gains were not observed. Increasing treatment may require the integration of substance use disorder treatment with other medical services and clinical interventions to motivate people to engage in treatment.

Posttraumatic stress symptoms, shame, and substance use among Asian Americans

BACKGROUND

To examine the association between posttraumatic stress symptoms (PTSS) and substance use among Asian Americans and the influence of a culturally-relevant moderator, shame.

METHODS

From 2016 to 2017, 199 participants from Amazon Mechanical Turk and a university subject pool completed an online survey. Chi-square and Kruskal-Wallis tests explored demographic and clinical differences among three Asian American ethnic subgroups (East Asians, South Asians, and Southeast Asians). Generalized linear models assessed the association between PTSS and substance use (alcohol, tobacco, and other drugs) and the moderation of this relationship by shame.

RESULTS

Ethnic subgroups significantly differed on all three substance use variables. The severity in PTSS was significantly associated with hazardous drug use (IRR = 1.03, (1.01, 1.05), p = .003). The association between PTSS and days of tobacco use and binge drinking was significantly moderated by shame. Low levels of shame increased the effect of PTSS on binge drinking (IRR = 1.05, (1.00, 1.10), p = .035) and tobacco use (IRR = 1.15, (1.11, 1.19), p < .001). High levels of shame had no effect of PTSS on binge drinking (IRR = 1.01, (0.99, 1.03), p = .54) and a reduced effect on tobacco use (IRR = 1.07, (1.05, 1.09), p < .001).

CONCLUSIONS

Among Asian Americans, the association of PTSS and substance use depends on shame. Lower levels of shame are a risk factor, increasing the effect of PTSS on substance use. Culturally-modified addiction treatments should assess for shame among Asian Americans and attend to ethnic sub-group diversity in substance use.

Treatment of alcohol use disorder among people of South Asian ancestry in Canada and the United States: A narrative review

To explore access and treatment for alcohol use disorders (AUDs) among people of South Asian ancestry living in Canada or the United State, EQUATOR guidelines were applied to 34 manuscripts identified through an English language literature search (1946-2017) for this narrative review. The population studied has poor access to and engagement with treatment for AUD. Early evidence suggests benefit from adopting language-specific materials, offering South Asian-specific therapy groups, and incorporating traditional healers. Specific engagement and therapy considerations may increase AUD treatment access and effectiveness among South Asians living in Canada or the United States.

Structural factors affecting Asians and Pacific Islanders in community-based substance use treatment: Treatment provider perspectives

Asians and Pacific Islanders (API) have large disparities in utilization of substance use treatment compared to other racial groups. In this study, we analyzed factors that shape API experiences accessing and engaging in community-based treatment from the perspective of treatment providers. We conducted semi-structured interviews with 40 treatment providers who work with API clients in treatment programs in San Francisco and Los Angeles. We analyzed the transcribed interview data in ATLAS.ti using a content analysis approach. There were three main findings. First, treatment providers found the API category itself is too broad and heterogeneous to meaningfully explain substance use patterns. Second, beyond race/ethnicity, structural factors such as poverty, neighborhood, housing, and age had an impact on API substance use. Third, factors such as family, immigration status, religion, language, stigma played complex roles in API treatment experiences, contingent on how client, programs, and providers attended to differences in these categories.

Drug use among Asian Americans: Differentiating use by acculturation status and gender

This study examined past-year drug use among Asian Americans with respect to ethnic subgroup, acculturation, and gender differences. Survey data were collected during the National Latino and Asian American Survey, a national epidemiological household survey of behavioral health prevalence and service utilization rates. The analytical sample consisted of 505 Filipino, 598 Chinese, 518 Vietnamese, and 466 other Asian respondents. Results indicated that among ethnic subgroups, Filipinos had the highest rates of drug use. Among all Asian Americans, those who were born in the United States, those with higher levels of English proficiency, males, those who were younger, those with lifetime prevalence of a major depressive episode, and those who were frequent drinkers were all more likely to have reported past-year drug use. Findings suggest the need to better understand the heterogeneous character of Asian American drug use when considering the provision of culturally competent and linguistically appropriate prevention and treatment services.

Asian American and Pacific Islander substance use treatment admission trends

BACKGROUND

A national analysis of Asian Americans and Pacific Islanders (AAPI) substance use treatment admissions has yet to be studied. We sought to explore admission trends for AAPI, demographic and treatment variable change, and individual state admission change over time.

METHODS

We used retrospective time-series logistic regression treating year as a predictor of yearly treatment admission trends, between-state test for heterogeneity of treatment effects among states' AAPI admissions, and percent-changes of AAPI demographic and treatment characteristics. Participants included AAPI (n=135,356) and comparison non-AAPI (n=8,938,982) treatment groups' first-time admissions (N=9,074,338) in United States treatment centers receiving public funding from 2000 to 2012.

RESULTS

AAPI demonstrated a greater increase in admissions than non-AAPI from 2000 to 2012 (p<0.0001; OR=1.02, 95% CI=1.019-1.022). Large percent increases were demonstrated in multiple demographic and treatment characteristic, most notably in prescription opioids as a problem substance, age of first use for the oldest and youngest groups, and homelessness. In addition, trends are provided for individual states to help prioritize resource need.

CONCLUSIONS

The present demographic and treatment characteristics revealed specific variables that may help to improve a culturally competent understanding of increasing risk factors among AAPI clients. The present findings may help to demonstrate which states may need to increase AAPI-specific resources and interventions.

Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups

Data from approximately 140 articles and reports published since 2000 on drinking, alcohol use disorder (AUD), correlates of drinking and AUD, and treatment needs, access, and utilization were critically examined and summarized. Epidemiological evidence demonstrates alcohol-related disparities across U.S. racial/ethnic groups. American Indians/Alaska Natives generally drink more and are disproportionately affected by alcohol problems, having some of the highest rates for AUD. In contrast, Asian Americans are less affected. Differences across Whites, Blacks, and Hispanics are more nuanced. The diversity in drinking and problem rates that is observed across groups also exists within groups, particularly among Hispanics, Asian Americans, and American Indians/Alaska Natives. Research findings also suggest that acculturation to the United States and nativity affect drinking. Recent studies on ethnic drinking cultures uncover the possible influence that native countries' cultural norms around consumption still have on immigrants' alcohol use. The reasons for racial/ethnic disparities in drinking and AUD are complex and are associated with historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage. This disadvantage is present at both individual and environmental levels. Finally, these data indicate that admission to alcohol treatment is also complex and is dependent on the presence and severity of alcohol problems but also on a variety of other factors. These include individuals' sociodemographic characteristics, the availability of appropriate services, factors that may trigger coercion into treatment by family, friends, employers, and the legal system, and the overall organization of the treatment system. More research is needed to understand facilitators and barriers to treatment to improve access to services and support. Additional directions for future research are discussed.

Failure to get into substance abuse treatment

Among substance abusers in the US, the discrepancy in the number who access substance abuse treatment and the number who need treatment is sizable. This results in a major public health problem of access to treatment. The purpose of this study was to examine characteristics of Persons Who Use Drugs (PWUDs) that either hinder or facilitate access to treatment. 2646 participants were administered the Risk Behavior Assessment (RBA) and the Barratt Impulsiveness Scale. The RBA included the dependent variable which was responses to the question "During the last year, have you ever tried, but been unable, to get into a drug treatment or detox program?" In multivariate analysis, factors associated with being unable to access treatment included: Previously been in drug treatment (OR=4.51), number of days taken amphetamines in the last 30days (OR=1.18), traded sex for drugs (OR=1.53), homeless (OR=1.73), Nonplanning subscale of the Barratt Impulsiveness Scale (OR=1.19), age at interview (OR=0.91), and sexual orientation, with bisexual men and women significantly more likely than heterosexuals to have tried but been unable to get into treatment. The answers to the question on "why were you unable to get into treatment" included: No room, waiting list; not enough money, did not qualify, got appointment but no follow through, still using drugs, and went to jail before program start. As expected, findings suggest that limiting organizational and financial obstacles to treatment may go a long way in increasing drug abuse treatment accessibility to individuals in need. Additionally, our study points to the importance of developing approaches for increasing personal planning skills/reducing Nonplanning impulsivity among PWUDs when they are in treatment as a key strategy to ensure access to additional substance abuse treatment in the future.

Mortality Rates Among Substance Use Disorder Participants in Clinical Trials: Pooled Analysis of Twenty-Two Clinical Trials Within the National Drug Abuse Treatment Clinical Trials Network

BACKGROUND

Most substance use disorders (SUD) treatment clinical trials are too short and small to reliably estimate the incidence of rare events like death.

OBJECTIVE

The aim of this study is to estimate the overall mortality rates among a SUD treatment-seeking population by pooling participants from multiple clinical trials conducted through the National Institute on Drug Abuse (NIDA)-sponsored National Drug Abuse Treatment Clinical Trials Network (CTN).

PARTICIPANTS

Drug and or alcohol users (N=9866) who sought treatment and participated in one of the twenty-two CTN trials.

MEASUREMENTS

Data were collected through randomized clinical trials in national community treatment programs for SUD. Pooled analysis was performed to assess age- and gender-standardized mortality rate(s) (SM rate(s)), and mortality ratio(s) (SM ratio(s)) of CTN trial participants compared to the U.S. general population.

RESULTS

The age- and gender-SM rate among CTN trials participants was 1403 (95% CI: 862-2074) per 100,000 person years (PY) compared to 542 (95% CI: 541-543) per 100,000 PY among the U.S. general population in 2005. By gender, age-adjusted SM ratio for female CTN trial participants was over five times (SM ratio=5.35, 95% CI: 3.31-8.19)), and for male CTN trial participants, it was over three times (SM ratio=3.39, 95% CI: 2.25-4.90) higher than their gender comparable peers in the U.S. general population.

CONCLUSIONS

Age and gender-standardized mortality rates and ratios among NIDA CTN SUD treatment-seeking clinical trial participants are higher than the age and gender comparable U.S. general population. The overall mortality rates of CTN trial participants are similar to in-treatment mortality reported in large U.S. and non-U.S. cohorts of opioid users. Future analysis with additional CTN trial participants and risk times will improve the stability of estimates, especially within subgroups based on primary substance of abuse. These SUD mortality rates can be used to facilitate safety monitoring within SUD clinical trials.

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations

OBJECTIVES

To review the literature on the screening, brief intervention, and referral to treatment (SBIRT) approach to alcohol and drug use with racial and ethnic subgroups in the United States and to develop recommendations for culturally competent SBIRT practice.

METHODS

Articles reporting on the use of SBIRT components (screening, brief intervention, referral to treatment) for alcohol and drug use were identified through a comprehensive literature search of PubMed from 1995 to 2015.

RESULTS

A synthesis of the published literature on racial and ethnic considerations regarding SBIRT components (including motivational interviewing techniques) was created using evidence-based findings. Recommendations on culturally competent use of SBIRT with specific ethnic groups are also described.

CONCLUSIONS

On the basis of the literature reviewed, SBIRT offers a useful set of tools to help reduce risky or problematic substance use. Special attention to validated screeners, appropriate use of language/literacy, trust building, and incorporation of patient and community health care preferences may enhance SBIRT acceptability and effectiveness.

PRACTICE IMPLICATIONS

Providers should consider the implications of previous research when adapting SBIRT for diverse populations, and use validated screening and brief intervention methods. The accompanying case illustration provides additional information relevant to clinical practice.

Perceived cannabis use norms and cannabis use among adolescents in the United States

Due to changes in cannabis policies, concerns about cannabis use (CU) in adolescents have increased. The population of nonwhite groups is growing quickly in the United States. We examined perceived CU norms and their association with CU and CU disorder (CUD) for White, Black, Hispanic, Native-American, Asian-American, Native Hawaiian/Pacific Islander (NH/PI), and mixed-race adolescents. Data were from adolescents (12-17 years) in the 2004-2012 National Surveys on Drug Use and Health (N = 163,837). Substance use and CUD were assessed by computer-assisted, self-interviewing methods. Blacks, Hispanics, Native-Americans, and mixed-race adolescents had greater odds of past-year CU and CUD than Whites. Among past-year cannabis users (CUs), Hispanics and Native-Americans had greater odds of having a CUD than Whites. Asian-Americans had the highest prevalence of perceived parental or close friends' CU disapproval. Native-Americans and mixed-race adolescents had lower odds than Whites of perceiving CU disapproval from parents or close friends. In adjusted analyses, adolescent's disapproval of CU, as well as perceived disapproval by parents or close friends, were associated with a decreased odds of CU in each racial/ethnic group, except for NHs/PIs. Adolescent's disapproval of CU was associated with a decreased odds of CUD among CUs for Whites (personal, parental, and close friends' disapproval), Hispanics (personal, parental, and close friends' disapproval), and mixed-race adolescents (personal, close friends' disapproval). Racial/ethnic differences in adolescent CU prevalence were somewhat consistent with adolescents' reports of CU norm patterns. Longitudinal research on CU health effects should oversample nonwhite adolescents to assure an adequate sample for analysis and reporting.

Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders

BACKGROUND

Asian Americans (AAs) and Native Hawaiians/Pacific Islanders (NHs/PIs) are the fastest growing segments of the US population. However, their population sizes are small, and thus AAs and NHs/PIs are often aggregated into a single racial/ethnic group or omitted from research and health statistics. The groups' substance use disorders (SUDs) and treatment needs have been under-recognized.

METHOD

We examined recent epidemiological data on the extent of alcohol and drug use disorders and the use of treatment services by AAs and NHs/PIs.

RESULTS

NHs/PIs on average were less educated and had lower levels of household income than AAs. Considered as a single group, AAs and NHs/PIs showed a low prevalence of substance use and disorders. Analyses of survey data that compared AAs and NHs/PIs revealed higher prevalences of substance use (alcohol, drugs), depression and delinquency among NHs than among AAs. Among treatment-seeking patients in mental healthcare settings, NHs/PIs had higher prevalences of DSM-IV diagnoses than AAs (alcohol/drug, mood, adjustment, childhood-onset disruptive or impulse-control disorders), although co-morbidity was common in both groups. AAs and NHs/PIs with an SUD were unlikely to use treatment, especially treatment for alcohol problems, and treatment use tended to be related to involvement with the criminal justice system.

CONCLUSIONS

Although available data are limited by small sample sizes of AAs and NHs/PIs, they demonstrate the need to separate AAs and NHs/PIs in health statistics and increase research into substance use and treatment needs for these fast-growing but understudied population groups.

Nonmedical stimulant use among young Asian-Americans, Native Hawaiians/Pacific Islanders, and mixed-race individuals aged 12-34 years in the United States

There are concerns over nonmedical use of prescription stimulants among youths, but little is known about the extent of use among young Asian-Americans, Native Hawaiians/Pacific Islanders (NHs/PIs), and mixed-race individuals-the fastest growing segments of the U.S. population. We examined prevalences and correlates of nonmedical stimulant use (NMSU) and disorder (StiUD) for these underrecognized groups. Whites were included as a comparison. Data were from young individuals aged 12-34 years in the 2005-2012 National Surveys on Drug Use and Health. We used logistic regression to estimate odds of past-year NMSU status. Significant yearly increases in lifetime NMSU prevalence were noted in Whites only. NHs/PIs (lifetime 7.33%, past-year 2.72%) and mixed-race individuals (10.20%, 2.82%) did not differ from Whites in NMSU prevalence (11.68%, 3.15%). Asian-Americans (lifetime 3.83%, past-year 0.90%) had lower prevalences than Whites. In each racial/ethnic group, "Methamphetamine/Desoxyn/Methedrine or Ritalin" was more commonly used than other stimulant groups; "got them from a friend/relative for free" and "bought them from a friends/relative" were among the most common sources. Females had greater odds than males of NMSU (among White, NH/PI, mixed-race individuals) and StiUD (among mixed-race individuals). Young adults (aged 18-25) had elevated odds of NMSU (White, NH/PI); adolescents had elevated odds of StiUD (White, mixed-race). Other substance use (especially marijuana, other prescription drugs) increased odds of NMSU and StiUD. NHs/PIs and mixed-race individuals were as likely as Whites to misuse stimulants. Research is needed to delineate health consequences of NMSU and inform prevention efforts for these understudied, rapidly-growing populations.

Challenges to providing quality substance abuse treatment services for American Indian and Alaska Native communities: perspectives of staff from 18 treatment centers

BACKGROUND

Substance abuse continues to exact a significant toll, despite promising advancements in treatment, and American Indian and Alaska Native (AI/AN) communities remain disproportionately impacted. Understanding the challenges to providing quality substance abuse treatment to AI/AN communities could ultimately result in more effective treatment interventions, but no multi-site studies have examined this important issue.

METHODS

This qualitative study examined the challenges of providing substance abuse treatment services for American Indian and Alaska Native (AI/AN) communities. We conducted key informant interviews and focus groups at 18 substance abuse treatment programs serving AI/AN communities. Seventy-six service participants (21 individuals in clinical administrative positions and 55 front-line clinicians) participated in the project. Interview transcripts were coded to identify key themes.

RESULTS

We found that the challenges of bringing effective substance abuse treatment to AI/AN communities fell into three broad categories: challenges associated with providing clinical services, those associated with the infrastructure of treatment settings, and those associated with the greater service/treatment system. These sets of challenges interact to form a highly complex set of conditions for the delivery of these services.

CONCLUSIONS

Our findings suggest that substance abuse treatment services for AI/AN communities require more integrated, individualized, comprehensive, and longer-term approaches to care. Our three categories of challenges provide a useful framework for eliciting challenges to providing quality substance abuse treatment in other substance abuse treatment settings.

A conceptual model to facilitate transitions from primary care to specialty substance use disorder care: a review of the literature

AIM

This article presents a conceptual model to help facilitate the transition from primary care to specialty substance use disorder (SUD) care for appropriate patients.

BACKGROUND

Substance misuse is a common health condition among patients presenting to primary care settings and may complicate the treatment of chronic health conditions such as diabetes and hypertension. It is therefore critical that primary care providers be prepared to identify and determine appropriate treatment options for patients presenting with substance misuse.

METHODS

We conducted a narrative review that occurred in three stages: literature review of health care transition models, identification of conceptual domains common across care transition models, and identification of SUD-specific model elements. Findings The conceptual model presented describes patient, provider, and system-level facilitators and barriers to the transition process, and includes intervention strategies that can be utilized by primary care clinics to potentially improve the process of transitioning patients from primary care to SUD care. Recognizing that primary care clinics vary in available resources, we present three examples of care practices along an intensity continuum from low (counseling and referral) to moderate (telephone monitoring) to high (intensive case management) resource demands for adoption. We also provide a list of common outcomes clinics might consider when evaluating the impact of care transition practices in this patient population; these include process outcomes such as patients' increased knowledge of available treatment resources, and health outcomes such as patients' reduced substance use and better quality of life.

Introducing dyadic interviews as a method for collecting qualitative data

In dyadic interviews, two participants interact in response to open-ended research questions. There are few precedents for using dyadic interviews as a technique for qualitative research. We introduce this method largely in comparison to focus groups, because both represent forms of interactive interviewing. We do not, however, view dyadic interviews as miniature focus groups, and treat them as generating their own opportunities and issues. To illustrate the nature of dyadic interviewing, we present summaries of three studies using this method. In the first study, we used dyadic interviews and photovoice techniques to examine experiences of people with early-stage dementia. In the second study, we explored the experiences of staff who provided services to elderly housing residents. In the third study, we examined barriers and facilitators to substance abuse treatment among Asian Americans and Pacific Islanders in Hawaii. We conclude with a discussion of directions for future research using dyadic interviews.