The global movement towards a public health approach to substance use disorders

Harm reduction in substance use: perspectives and experiences of community volunteers and student interns in Durban, South Africa

BACKGROUND

Substance abuse is a significant public health concern globally, exposing individuals to substantial health risks and mortality. Despite the effectiveness of harm reduction interventions, they remain limited and inadequately accessible in South Africa, where substance use prevalence is increasing. This study explores the perspectives of community volunteers and student interns on harm reduction and its interventions using Bellhaven Harm Reduction Centre as a case study.

METHODS

This qualitative study employed a cross-sectional design, utilising thematic analysis to examine the views of 15 participants on harm reduction programs and their experiences within the harm reduction centre context.

RESULTS

The findings indicate that harm reduction interventions have a positive impact on all stakeholders, fostering transformative attitudes toward substance use and promoting empathy and understanding. Our findings highlight four major themes: the client-focused nature of harm reduction interventions, their ability to reduce stigma and discrimination against marginalised populations, their capacity-building nature, and ability to reduce substance abuse-related harm.

CONCLUSION

This study highlights the value of harm reduction programs in addressing substance use challenges, emphasizing client-centered care, capacity building, and stigma reduction. The findings provide a valuable model for resource-constrained environments, informing policy and practice to improve health outcomes among vulnerable populations.

Racial Disparities in Outpatient Substance Use Disorder Treatment Completion: Trends and Changes from 2004 to 2024

Racial disparities have been found in outpatient substance use disorder (SUD) treatment completion rates. Improvements in access to treatment have sought to decrease these disparities and increase treatment engagement and success. To understand outcomes among different racial groups across time, we assessed (1) completion rates, (2) racial representation among patients who have completed treatment, (3) general representation of racial groups within treatment, and (4) treatment length between 2004 and 2024. "Completion" is defined as "meeting all treatment goals". Chi-squared analyses suggest significant differences among racial groups within the completed (x215=158.0, p=<0.001), not-completed (x215=561.75, p=<0.001), and other (x215=186.19, p=<0.001) groups across time. Asian and Other/Multiracial patients experienced the greatest improvement in both representation within treatment overall and proportional representation within the "completer" group over time, despite their overall completion rates fluctuating. White and Black/African American patients decreased in representation, completion rates, and representation in the "completer" group over time, with a peak in 2004-2009. In terms of length of stay, White patients remained in treatment the longest across time, F(5, 4198) = 24.605, p < 0.011, and treatment length increased for other racial groups. While disparities in completion rates decreased and racial representation in treatment increased, discrepancies persist. We discuss these findings within the context of evolving patient populations and changes in treatment provision (e.g., harm reduction frameworks).

Mental Health of Adolescents Exposed to the War in Ukraine

Importance

With exposure to traumatic events and reduced access to mental health care, adolescents of Ukraine during the Russian invasion since February 2022 are at high risk of psychiatric conditions. However, the actual mental health burden of the war has scarcely been documented.

Objective

To investigate the prevalence of a positive screen for psychiatric conditions among adolescents amidst the ongoing war in Ukraine as well as their associations with war exposure.

Design, Setting, and Participants

This cross-sectional study reports the results from the first wave of the Adolescents of Ukraine During the Russian Invasion cohort, the largest cohort study on Ukrainian adolescents' mental health during the Russian invasion since 2022. Using self-reported questionnaires, the national-level prevalence of a positive screen for various psychiatric conditions was estimated among adolescents aged 15 years or older attending secondary school in Ukraine in person or online (including those residing abroad but attending Ukrainian secondary school online) and the prevalence among Ukrainian adolescents living abroad due to the war.

Exposure

Self-reported exposure to war.

Main Outcomes and Measures

A positive screen for psychiatric conditions. The association between self-reported war exposure and a positive screen for each of the psychiatric conditions was also evaluated.

Results

A total of 8096 Ukrainian adolescents (4988 [61.6%] female) living in Ukraine or abroad were included in the analyses. Based on national-level estimates, 49.6% of the adolescents were directly exposed to war, 32.0% screened positive for moderate or severe depression, 17.9% for moderate or severe anxiety, 35.0% for clinically relevant psychological trauma, 29.5% for eating disorders, and 20.5% for medium risk or higher of substance use disorder. The burden of psychiatric symptoms was similarly large among Ukrainian adolescents living abroad. Adolescents exposed to war were more likely to screen positive for depression (prevalence ratio [PR], 1.39; 95% CI, 1.29-1.50), anxiety (PR, 1.62; 95% CI, 1.45-1.81), clinically relevant psychological trauma (PR, 1.41; 95% CI, 1.32-1.50), eating disorders (PR, 1.21; 95% CI, 1.12-1.32), and substance use disorder (PR, 1.11; 95% CI, 0.98-1.25).

Conclusions and Relevance

The findings of this study suggest that the mental health burden of Ukrainian adolescents amidst the Russian invasion of Ukraine is substantial. Mental health care efforts to alleviate the mental health burden of Ukrainian adolescents are needed.

Equine-assisted therapy effectiveness in improving emotion regulation, self-efficacy, and perceived self-esteem of patients suffering from substance use disorders

Substance Use Disorders (SUD) is a universal overwhelming public health problem and is associated with other psychological and mental health ailments such as emotion regulation, perceived self-esteem, and self-efficacy problems. Complementary and alternative medicine may be beneficial. The aim of this study was to assess the effectiveness of equine-assisted therapy in improving emotion regulation, self-efficacy, and perceived self-esteem among patients suffering from substance use disorders. It was carried out using a randomized controlled trial design at Behman hospital, Cairo, Egypt. It included 100 patients suffering from SUD attending the setting, equally randomized into an intervention group to receive the equine assisted therapy and a control group to receive the regular care. Data were collected using a self-administered questionnaire with standardized tools for assessment of emotion regulation, General Self-Efficacy (GSE), and perceived self-esteem. The intervention group received weekly equine-assisted therapy sessions over 6 weeks in addition to their standard regular therapy. Patients in both groups had similar demographic and SUD characteristics, as well as baseline scores of reappraisals, suppression, GSE and perceived self-esteem. At post-intervention, the intervention group had significant improvements in all these scores in comparison with the control group, as well as their baseline. The multivariate analysis identified the study intervention as a significant positive predictor of the reappraisal and GSE scores, and a negative predictor of the suppression and perceived self-esteem negative score. In conclusion, equine assisted-therapy as a complementary treatment in patients suffering from SUD is effective in improving their emotion regulation, self-efficacy, and perceived self-esteem. A wider use of this approach is recommended in SUD patients along with provision of needed facilities and resources, and training nurses in its administration. Further research is proposed to assess its long-term effectiveness. The clinical trial was registered in the "Clinical Trials.gov Protocol Registration and Results System (PRS);" registration number is (05632185/2022) and the full date of first registration is 10/11/2022.