1
|
Fujita AW, Ramakrishnan A, Mehta CC, Yusuf OB, Wilson T, Shoptaw S, Carrico AW, Adimora AA, Eaton E, Cohen MH, Cohen J, Adedimeji A, Plankey M, Jones D, Chandran A, Colasanti JA, Sheth AN. Substance Use Treatment Utilization Among Women With and Without Human Immunodeficiency Virus. Open Forum Infect Dis 2023; 10:ofac684. [PMID: 36655189 PMCID: PMC9835749 DOI: 10.1093/ofid/ofac684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Substance use (SU) contributes to poor health outcomes, yet limited data exist to inform strategies to optimize SU treatment among persons with human immunodeficiency virus (HIV). We describe SU and SU treatment utilization among women with and without HIV in the Women's Interagency HIV Study (WIHS). Methods We included data from women enrolled in WIHS from 2013 to 2020. Current SU was self-reported, nonmedical use of drugs in the past year, excluding use of only marijuana. SU treatment utilization was self-reported use of a drug treatment program in the past year. Multivariable regression models were used to investigate associations between participant characteristics and SU treatment. Results Among 2559 women (1802 women living with HIV [WWH], 757 women without HIV), 14% reported current SU. Among those with current SU (n = 367), 71% reported crack/cocaine followed by 40% reporting opioids, and 42% reported any treatment in the past year. The most common treatments were methadone (64%), Narcotics Anonymous (29%), inpatient programs (28%), and outpatient programs (16%). Among women using opioids (n = 147), 67% reported methadone use in the past year compared to 5% using buprenorphine/naloxone. Multivariable analysis showed lower odds of treatment utilization among WWH with concurrent alcohol or marijuana use. Visiting a psychiatrist/counselor was associated with higher odds of treatment. Among WWH, SU treatment was not associated with HIV-related clinical outcomes. Conclusions Treatment utilization was high, especially for methadone use. Our results highlight opportunities for accessing SU treatment for WWH, such as the need to prioritize buprenorphine and comprehensive, wraparound services in HIV care settings.
Collapse
Affiliation(s)
- Ayako W Fujita
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Aditi Ramakrishnan
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Infectious Diseases, School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - C Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Oyindamola B Yusuf
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tracey Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ellen Eaton
- Division of Infectious Diseases, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Jennifer Cohen
- Department of Medicine, Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
| | - Adebola Adedimeji
- Division of Health Behavior Research and Implementation Science, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Plankey
- Division of General Internal Medicine, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Deborah Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Infectious Disease Program, Grady Health System, Atlanta, Georgia, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Hansen MA, Modak S, McMaster S, Zoorob R, Gonzalez S. Implementing peer recovery coaching and improving outcomes for substance use disorders in underserved communities. J Ethn Subst Abuse 2020; 21:1029-1042. [PMID: 32969329 DOI: 10.1080/15332640.2020.1824839] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The Peer Recovery Expansion Project (PREP) was designed to expand outreach and deliver enhanced treatment services via peer-recovery coaches for individuals with substance use disorder (SUD) and limited access to healthcare. METHODS PREP was implemented in low-socioeconomic areas with historic challenges to accessing SUD treatment. Services were provided to 153 clients through tailored cultural responsiveness, use of peer-based recovery coaching, and development of a Recovery Support Network. Outcome data were collected using the Government Performance and Reporting Act tool at intake and at 6-month follow-up for coaches and clients. RESULTS The vast majority of peer-recovery coaches were satisfied with the overall quality of the training and their training experience (96.8%). Around 95% agreed that the training enhanced their skills in the topic area and 93% agreed that the training was relevant to substance use disorder treatment at the 6-month post training survey. Majority of clients were from low-income, minority demographics that had a high prevalence history of incarceration, homelessness, and inconsistent employment. At 6-month follow-up, they reported a 22% increase in stable housing and a 25% increase in full-time/part-time employment/training program enrollment. They also demonstrated a significant decline in reported depression, anxiety, and prescribed medication use at 6-month follow-up when compared to baseline. CONCLUSIONS Clients enrolled in a tailored evidence based peer-led program decreased their psychiatric symptoms and increased their housing stability and employment. Study outcomes support the use of an integrated peer-led support for increasing engagement in care for adults experiencing substance use disorders.
Collapse
Affiliation(s)
| | - Sanjukta Modak
- Family Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Samuel McMaster
- Family Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Roger Zoorob
- Family Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sandra Gonzalez
- Family Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
3
|
Redmond ML, Smith S, Collins TC. Exploring African-American womens' experiences with substance use treatment: A review of the literature. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:337-350. [PMID: 31609461 PMCID: PMC7032990 DOI: 10.1002/jcop.22241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 06/11/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
The aim of this systematic review is to synthesize evidence on treatment barriers among African-American women who seek treatment for substance use disorders. The authors reviewed articles from 1995 to 2018 on the topic of substance use disorders among African-American women. Based on the review of 13 articles, we found African-American women were more likely to encounter treatment readiness barriers compared to access barriers and system-related barriers. Personal and interpersonal barriers were more readily identified throughout the literature reviewed. However, African-American women did encounter other barriers such as access- and system-related barriers. In addition, the intersection of race, gender, and class was not addressed in the specific articles, but should be considered when working to remove treatment barriers for this population. While prevalence of alcohol and drug use is limited among African-American women, it is important to understand how treatment readiness barriers may limit successful completion of treatment and ongoing progress. Implications for treatment and future research in addressing barriers to treatment for African-American women are discussed.
Collapse
Affiliation(s)
- Michelle L Redmond
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | - Sharla Smith
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | - Tracie C Collins
- College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
4
|
Stevens-Watkins D, Knighton JS, Allen K, Fisher S, Crowell C, Mahaffey C, Leukefeld C, Oser C. John Henryism Active Coping as a Cultural Correlate of Substance Abuse Treatment Participation Among African American Women. J Subst Abuse Treat 2016; 63:54-60. [PMID: 26899801 PMCID: PMC4793159 DOI: 10.1016/j.jsat.2016.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 12/21/2015] [Accepted: 01/10/2016] [Indexed: 11/30/2022]
Abstract
The rates of illicit drug use among African American women are increasing, yet African American women are least likely to participate in treatment for substance use disorders when compared to women of other racial groups. The current study examined family history of substance use, perceived family support, and John Henryism Active Coping (JHAC) as correlates to seeking treatment for substance abuse. The underlying theoretical frame of JHAC (James et al., 1983) suggests that despite limited resources and psychosocial stressors, African Americans believe that hard work and self-determination are necessary to cope with adversities. The current study is a secondary data analyses of 206 drug-using African American women (N=104 urban community women with no criminal justice involvement and N=102 women living in the community on supervised probation) from urban cities in a southern state. It was expected that African American women with a family history of substance abuse, higher levels of perceived family support, and more active coping skills would be more likely to have participated in substance abuse treatment. Step-wise logistic regression results reveal that women on probation, had children, and had a family history of substance abuse were significantly more likely to report participating in substance abuse treatment. Perceived family support and active coping were significant negative correlates of participating in treatment. Implication of results suggests coping with psychosocial stressors using a self-determined and persistent coping strategy may be problematic for drug-using women with limited resources.
Collapse
|
5
|
Stevens SJ, Andrade RAC, Ruiz BS. Women and substance abuse: gender, age, and cultural considerations. J Ethn Subst Abuse 2016; 8:341-58. [PMID: 25985074 DOI: 10.1080/15332640903110542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Historically, data has shown that a smaller percentage of women use alcohol and illicit substances compared to men, and that frequency of use has been lower among women compared to use among men. Although this data on usage may be true, researchers also acknowledge that substance use among women has been a hidden issue, one not realistically acknowledged by society, especially prior to the mid-1960s. Along with this, more recent data indicates that rates of substance use among women are increasing. Factors contributing to this increase in substance abuse have begun to receive considerable attention, and recent research suggests that many issues exist that are unique to substance use among women. The purpose of this article is to discuss gender specific considerations in women's substance abuse by examining the history of substance use among women; analyzing gender-specific factors, including physiological factors, trauma-related factors, mental health issues, and cultural considerations that impact on women's substance use; articulating treatment approaches for working with substance abusing women and girls; and providing recommendations for further research in this area.
Collapse
Affiliation(s)
- Sally J Stevens
- a Southwest Institute for Research on Women, University of Arizona , Tucson , Arizona
| | | | | |
Collapse
|
6
|
Meshberg-Cohen S, Presseau C, Thacker LR, Hefner K, Svikis D. Posttraumatic Stress Disorder, Health Problems, and Depression Among African American Women in Residential Substance Use Treatment. J Womens Health (Larchmt) 2016; 25:729-37. [PMID: 27387193 DOI: 10.1089/jwh.2015.5328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rates of posttraumatic stress disorder (PTSD) are high among women seeking treatment for substance use disorders (SUDs). Minority women, in particular, experience high rates of trauma and may be less likely to disclose trauma history. This article identifies items from pre-existing screening measures that can be used across settings to sensitively but noninvasively identify women with likely PTSD. METHOD For a sample of 104 African American women in residential SUD treatment who provided informed consent as a part of a larger randomized clinical trial, the prevalence of trauma and PTSD, as well as the relationships between trauma, health, depression, and distress, was examined. Measures included Posttraumatic Stress Diagnostic Scale (PDS), Center for Epidemiologic Studies-Depression Scale (CES-D), Pennebaker Inventory of Limbic Languidness (PILL), and Brief Symptom Inventory (BSI). Additional analyses were undertaken to determine if a subset of noninvasive items could serve to identify the presence of a probable PTSD diagnosis. RESULTS Most women (94.2%) reported at least one lifetime trauma, with over half (51.0%) meeting DSM-IV criteria for PTSD. Women with greater trauma symptom severity reported more health problems and higher levels of depression and distress. Five BSI items and one CES-D item were significantly associated with a probable PTSD diagnosis with a sensitivity of 88.7%, a specificity of 66.7%, a positive predictive value of 73.4%, a negative predictive value of 85.0%, and an accuracy of 77.9%. CONCLUSION Findings affirm that African American women with SUDs present for residential treatment with comorbid psychiatric and emotional conditions that warrant assessment and treatment. Results highlight potential benefits of brief screening with routine measures and coordinated access to ancillary psychiatric and medical services, in conjunction with substance treatment, such as in residential or primary care.
Collapse
Affiliation(s)
- Sarah Meshberg-Cohen
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut.,2 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Candice Presseau
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut
| | - Leroy R Thacker
- 3 Department of Family and Community Health Nursing, Virginia Commonwealth University , Richmond, Virginia
| | - Kathryn Hefner
- 1 Department of Veteran Affairs, VA Connecticut Healthcare System , West Haven, Connecticut.,2 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
| | - Dace Svikis
- 4 Department of Psychology, Virginia Commonwealth University , Richmond, Virginia
| |
Collapse
|
7
|
Bednasz C, Luque AE, Zingman BS, Fischl MA, Gripshover BM, Venuto CS, Gu J, Feng Z, DiFrancesco R, Morse GD, Ma Q. Lipid-Lowering Therapy in HIV-Infected Patients: Relationship with Antiretroviral Agents and Impact of Substance-Related Disorders. Curr Vasc Pharmacol 2016; 14:280-7. [PMID: 26733388 PMCID: PMC4879810 DOI: 10.2174/1570161114666160106151652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND The use of combination antiretroviral therapy (cART) has significantly decreased the morbidity and mortality associated with human immunodeficiency virus (HIV) infection. Lipid disorders, including lipodystrophy, hypertriglyceridemia, and hypercholesterolemia, remain the most commonly reported metabolic disorders among those treated with long-term cART. Mounting evidence suggests an association between drug abuse and poor glycemic control and diabetes complications. Substance related disorders (SRD) may increase the risk of metabolic syndrome. MATERIALS AND METHODS The aim of this retrospective cohort study was to examine the relationship between SRD, cART, and lipid-lowering agent use in an HIV infected population. Patients received efavirenz or protease inhibitor-based cART for at least 6 months. Prescription information was retrieved from the medical records. The primary outcome was the use of lipid-lowering agents including statins, fibrates and fish oil. The impact of SRD and cART was assessed on the lipid-lowering agent use. RESULTS A total of 276 subjects with HIV infection were included, 90 (33%) received lipid-lowering agents, and 31 (34%) had SRD. Smoking was prevalent among subjects with SRD (84 vs 15%, p<0.001). Statins were the mainstay for the management of dyslipidemia (66%), followed by the fibrates (24%), omega-3 fatty acids (5%), nicotinic acid (3%) and the cholesterol absorption inhibitors (3%). Use of statins or fibrates was significantly higher among subjects without SRD than those with (40 vs 23%, p=0.005). The type of cART, including efavirenz and protease inhibitors, appeared to have no significant impact on the use pattern of lipid-lowering agents. Lopinavir/ritonavir (lopinavir/r) was mostly prescribed for subjects with SRD (25 vs 8%, p=0.02). CONCLUSION Among HIV-infected patients, statins remain the mainstay for the management of dyslipidemia in routine clinical care, followed by fibrates. A significant high risk of metabolic disorders among patients with SRD is implicated by heavy tobacco use and prevalent lopinavir/r-based treatment. Significantly low rate of lipid-lowering agent use in this population underscores the importance of lipid disorder scrutiny and cART treatment optimization for HIV-infected patients with SRD.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Qing Ma
- Translational Pharmacology Research Core Center of Excellence in Bioinformatics and Life Sciences Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences University at Buffalo, Buffalo, NY 14214, USA.
| |
Collapse
|
8
|
Mericle AA, Miles J, Cacciola J. A critical component of the continuum of care for substance use disorders: recovery homes in Philadelphia. J Psychoactive Drugs 2015; 47:80-90. [PMID: 25715076 DOI: 10.1080/02791072.2014.976726] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
For many struggling with addiction, the ability to achieve stable recovery is often jeopardized by untenable housing or unsupportive living environments. Despite promising research on recovery residences, there are still significant gaps in the research on them. Using data collected from a stratified random sample of recovery homes in Philadelphia (N = 25), this study describes the organizational, operational, and programmatic characteristics of these homes and explores potential differences in these characteristics by funding source and gender of residents served. Although not licensed treatment providers, the majority of these homes operated in a recovery-oriented manner and offered a range of different services to their residents-all for a reasonable monthly fee (M = $340.40, SE = 18.60). Few differences emerged between homes that received funding from the Philadelphia Office of Addiction Services and those that did not or between those that served males as opposed to females. More research is needed to address resident outcomes and how Philadelphia recovery homes may compare with recovery residences in other parts of the country.
Collapse
Affiliation(s)
- Amy A Mericle
- a Research Scientist, Alcohol Research Group , Emeryville , CA
| | | | | |
Collapse
|
9
|
Browne T, Priester MA, Clone S, Iachini A, DeHart D, Hock R. Barriers and Facilitators to Substance Use Treatment in the Rural South: A Qualitative Study. J Rural Health 2015; 32:92-101. [PMID: 26184098 DOI: 10.1111/jrh.12129] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Little qualitative research has examined factors associated with care in substance abuse treatment agencies in Southeastern rural communities. This study explored client- and agency stakeholder-perceived barriers and facilitators to substance use treatment delivery in southeastern rural communities. METHODS Group and individual interviews were conducted with 40 key stakeholders and 40 clients at 9 substance abuse agencies serving rural communities in a southeastern state. Qualitative thematic analysis was used to identify perceived barriers and facilitators to substance abuse services in rural communities. FINDINGS Four primary themes emerged from the client and stakeholder interviews as both barriers and facilitators: availability of services for individuals with substance use disorders; access to the current technology for client services and agency functioning; cost of services; and stigma. CONCLUSIONS This study identifies novel barriers and facilitators to substance use care in the rural South and highlights essential areas for consideration when developing and implementing substance use care in this geographic region. These findings can be used as guidelines to provide better care to individuals with substance use disorders living in rural communities.
Collapse
|
10
|
Keen Ii L, Whitehead NE, Clifford L, Rose J, Latimer W. Perceived barriers to treatment in a community-based sample of illicit-drug-using African American men and women. J Psychoactive Drugs 2015; 46:444-9. [PMID: 25364997 DOI: 10.1080/02791072.2014.964382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examines perceived substance use treatment barriers in a community-based sample of 267 African Americans from Baltimore, MD. Both men and women endorsed "they can handle it alone" as a primary reason they were not currently in treatment. However, men were two times more likely (AOR = 2.29 CI = 1.05, 5.02) to endorse "concerns about losing family" as the reason they are not currently in treatment. The present study yields interesting findings among African Americans, which should be considered when creating interventions for particular groups of African Americans.
Collapse
Affiliation(s)
- Larry Keen Ii
- a Assistant Professor, Department of Psychology , Virginia State University , Petersburg , VA
| | | | | | | | | |
Collapse
|
11
|
Legha R, Raleigh-Cohn A, Fickenscher A, Novins D. Challenges to providing quality substance abuse treatment services for American Indian and Alaska Native communities: perspectives of staff from 18 treatment centers. BMC Psychiatry 2014; 14:181. [PMID: 24938281 PMCID: PMC4080609 DOI: 10.1186/1471-244x-14-181] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 06/10/2014] [Indexed: 01/18/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Rupinder Legha
- Department of Psychiatry, University of Colorado, 13001 E. 17th St., MSF546, Building 500, Aurora, CO 80045, USA
| | - Ashley Raleigh-Cohn
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Ave., Aurora, CO 80045, USA
| | - Alexandra Fickenscher
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Ave., Aurora, CO 80045, USA
| | - Douglas Novins
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Ave., Aurora, CO 80045, USA
| |
Collapse
|
12
|
Fischer B, Cruz MS, Bastos FI, Tyndall M. Crack across the Americas – A massive problem in continued search of viable answers: Exemplary views from the North (Canada) and the South (Brazil). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:631-3. [DOI: 10.1016/j.drugpo.2013.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/04/2013] [Accepted: 09/06/2013] [Indexed: 11/30/2022]
|
13
|
Santos Cruz M, Andrade T, Bastos FI, Leal E, Bertoni N, Villar LM, Tiesmaki M, Fischer B. Key drug use, health and socio-economic characteristics of young crack users in two Brazilian cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:432-8. [PMID: 23632130 DOI: 10.1016/j.drugpo.2013.03.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 03/13/2013] [Accepted: 03/20/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Crack use constitutes a major problem in cities across Brazil. While existing data suggest that crack use is generally concentrated among disenfranchised young people with extensive health problems and crime involvement, extensive data gaps exist. To address this issue, this study aimed to assess key characteristics of young crack users in two Brazilian cities. METHODS N=160 regular and young adult (ages 18-24) crack users were recruited by community-based methods in the cities of Rio de Janeiro (Southeast) and Salvador (Northeast). Assessments included an interviewer-administered questionnaire on key social, drug use, health and service use characteristics, as well as serological testing of HBV, HCV and HIV status, and were conducted anonymously between November 2010 and June 2011. Participants provided informed consent and received transportation vouchers following assessment completion. The study was approved by institutional ethics review boards. RESULTS The majority of participants were: male, with less than high school education, unstably housed (Rio only); gained income from legal or illegal work; arrested by police in past year (Salvador only); had numerous daily crack use episodes and shared paraphernalia (Salvador only); co-used alcohol, tobacco, cannabis and cocaine; had no injection history; rated physical and mental health as 'fair' or lower (Salvador only); had unprotected sex; were never HIV tested; were not HIV, HBV or HCV positive; and did not use existing social or health services, but desired access to crack user specific services. CONCLUSION Crack users in the two Brazilian sites featured extensive socio-economic marginalization, crack and poly-drug use as well as sexual risk behaviours, and compromised health status. Social and health service utilization are low, yet needs are high. There is an urgent need for further research and for targeted interventions for crack use in Brazil.
Collapse
Affiliation(s)
- Marcelo Santos Cruz
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Ribeiro DVA, Turato ER, Azevedo RCSD, Campos CJG. Views on treatment adherence among psychoactive substance-dependent women in the outpatient setting: a qualitative study. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2012; 34:198-206. [PMID: 25923068 DOI: 10.1590/s2237-60892012000400005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 08/24/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In the female population, adherence to specialist clinical treatment for psychoactive substance dependence has peculiar characteristics in terms of therapeutic approaches available to addicts in general. A smaller number of women seek specialist treatment in comparison with men. Traditionally, most health care services specializing in chemical dependence provide similar therapies to both men or women, including the use of mixed-sex groups at some facilities. OBJECTIVE To discuss the views or psychological meanings attributed by women with substance use disorders to phenomena associated with adherence to treatment at a specialist university outpatient clinic. METHODS The qualitative-clinical method was used, i.e., an approach characterized by the typically qualitative focus of human sciences adapted to health care settings. The semi-structured interview technique with open questions was used for data collection, combined with observation of the women interviewed. Data were processed using qualitative content analysis. RESULTS Three categories of treatment outcomes emerged: 1) significant motivations to seek and follow the treatment proposed; 2) symbolic meanings attributed to the drug; 3) psychological representations of lack of motivation to explain difficulties adhering to treatment. CONCLUSIONS Our findings suggest that the motivations of addicted women to seek treatment vary, but highlight the fact that the substance used becomes perceived as something that causes significant losses and hinders the proper exercise of women's role in family and social contexts. A warm welcoming is considered essential for a patient to adhere to treatment, offsetting the strong physical pleasure associated with psychoactive substance use.
Collapse
|
15
|
Therapeutic drug monitoring of protease inhibitors and efavirenz in HIV-infected individuals with active substance-related disorders. Ther Drug Monit 2011; 33:309-14. [PMID: 21544014 DOI: 10.1097/ftd.0b013e31821d3adb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Achieving targeted antiretroviral (ARV) plasma concentrations during long-term treatment in human immunodeficiency virus (HIV)-infected patients with substance-related disorders (SRDs) may be challenging due to a number of factors, including medication adherence, coinfection with hepatitis B or C virus, medication intolerance, and drug interactions. One approach to investigate these factors is to conduct therapeutic drug monitoring to measure ARV exposure during treatment. The objective of this study was to utilize therapeutic drug monitoring to compare efavirenz (EFV) and protease inhibitor pharmacokinetics in patients with and without SRDs. METHODS This was a multicenter, cross-sectional open-label study in patients with HIV-1 infection receiving antiretroviral therapy (ART), with active (n=129) or without (n=146) SRD according to National Institute on Drug Abuse criteria. Two hundred seventy-five subjects who were receiving either protease inhibitor-based or EFV-based ART regimens for >6 months were enrolled at 4 HIV treatment centers with an equal distribution of SRD and non-SRD at each site. The patients were instructed during enrollment visits with regard to the importance of adherence before and after study visits. Demographics and routine clinical laboratory tests were recorded. RESULTS Among the 275 patients, 47% had SRD with at least 1 substance. There were no significant differences between SRD and non-SRD groups for race, gender, age, or CD4 count at entry. A significantly higher proportion of patients with SRD had an entry HIV RNA plasma concentration>75 copies per milliliter compared with patients without SRD (40% vs 28%, P=0.044). Logistic regression modeling revealed an association between HIV RNA plasma concentration and African American race (P=0.017). A significantly higher proportion of SRDs also had an EFV or protease inhibitor trough concentration below the desired range (23% vs 9%, P=0.048). Significantly lower trough concentrations were noted in patients with SRDs receiving atazanavir (0.290 vs 0.976 μg/mL) or lopinavir (3.75 vs 5.30 μg/mL). CONCLUSIONS The pharmacokinetic data indicate differences between HIV-infected patients with and without SRDs that may influence viral load suppression during long-term ART. These findings require additional investigation in a randomized design with more intensive pharmacokinetic assessment to identify individual factors that are contributing to suboptimal ARV exposure in patients with SRDs.
Collapse
|
16
|
Morales-Manrique CC, Palepu A, Castellano-Gomez M, Aleixandre-Benavent R, Valderrama-Zurián JC. Quality of life, needs, and interest among cocaine users: differences by cocaine use intensity and lifetime severity of addiction to cocaine. Subst Use Misuse 2011; 46:390-7. [PMID: 20735213 DOI: 10.3109/10826084.2010.501675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We examined the quality of life (QoL) of 149 patients who were recruited in 2005 at outpatient treatment centers for cocaine dependence in Spain. Important life areas and life areas with potential need and interest to change in order to improve the QoL were analyzed in terms of patients? cocaine use intensity within the previous six months and lifetime severity addiction to cocaine. The Spanish versions of the Drug User Quality of Life Scale and the Lifetime Severity Index for Cocaine were used to measure QoL, needs and interest, and severity addiction to cocaine. The data analysis employed t-tests, linear regression, Mann?Whitney U tests, multivariate regression, and chi-square tests. Tailoring treatment programs to address the life areas that are considered relevant to cocaine users considering their intensity of consumption and lifetime severity addiction to cocaine may improve retention and treatment outcomes. Further research needs to consider patients of different ethnic backgrounds and cultural contexts. The study's limitations are noted.
Collapse
Affiliation(s)
- C C Morales-Manrique
- Unidad de Información e Investigación Social y Sanitaria (UISYS) (Universitat de València-CSIC), Valencia, Spain
| | | | | | | | | | | |
Collapse
|
17
|
Women's health and use of crack cocaine in context: structural and 'everyday' violence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:321-9. [PMID: 20116989 DOI: 10.1016/j.drugpo.2009.12.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 11/16/2009] [Accepted: 12/18/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is increasing public health evidence that women who use crack cocaine and are street-involved experience significant health problems and are more isolated with regards to accessing harm reduction and other health-related services. Simultaneously, there is growing acknowledgement that structural and 'everyday' violence are significant factors influencing the health of women who use illegal drugs. Little research has examined how these social processes play out for women who use crack cocaine. METHODS A critical ethnography informed by the theoretical constructs of structural and everyday violence and intersectionality was undertaken to explore women's use of crack cocaine within an inner-city neighbourhood in Western Canada. Data collection included baseline survey (n=126), participant observation and field notes, informal interviews (n=53), and in-depth interviews (n=13). RESULTS Based on thematic and theoretical analysis two interrelated themes were identified that reflected the interrelationships between women's use of crack, poverty, discrimination, racism, gendered relations of power, and legal policies and practices: (a) the context of health care; and (b) the smoking context. CONCLUSIONS Structural inequities and 'everyday' violence are perilously damaging for women who use crack. Interventions to reduce these inequities are urgently needed if we are to reduce the significant suffering of women who are street-involved and use crack cocaine.
Collapse
|
18
|
Cavaleri MA, Kalogerogiannis K, McKay MM, Vitale L, Levi E, Jones S, Wallach F, Flynn E. Barriers to HIV care: an exploration of the complexities that influence engagement in and utilization of treatment. SOCIAL WORK IN HEALTH CARE 2010; 49:934-945. [PMID: 21113849 DOI: 10.1080/00981389.2010.514563] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study is an exploration of engagement in outpatient medical care, medication utilization, and barriers to treatment utilization among 24 predominantly low-income, ethnic minority adults who were admitted to an urban hospital for HIV-related illnesses. A semi-structured interview was administered during the sample's hospital stay to explore patterns of service use and identify barriers to care. The majority of the sample was connected to an outpatient provider and satisfied with the care they received; however, most missed treatment appointments and skipped medication dosages. Health and treatment-related barriers, competing demands, and co-occurring mental health symptoms and illicit substance use were identified as barriers to care. Multiple obstacles indigenous to the individual, their treatment, and the environment prevented consistent treatment use among an economically disadvantaged ethnic minority sample: Implications and future directions in engaging vulnerable populations into health care for HIV are discussed.
Collapse
Affiliation(s)
- Mary A Cavaleri
- New York State Psychiatric Institute, 100 Haven Avenue #31D, New York, NY 10032, USA.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Okpaku S, Macmaster SA, Dennie S, Tolliver D, Cooper RL, Rasch RFR. Preliminary outcomes of a model program for increasing treatment access for African American women who use crack cocaine and are at risk for contracting HIV. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2010; 7:41-57. [PMID: 20178024 DOI: 10.1080/15433710903175874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In the United States, the threat of HIV/AIDS to African American women's health has become the focus of much concern. This paper describes a federally funded community-based program that provides services to African American women at risk for HIV/AIDS in Nashville, Tennessee. The program provides a culturally relevant set of interventions specific to crack cocaine users aimed at reducing substance use and HIV/AIDS risk behaviors. The model is important for the continued development of culturally relevant interventions aimed at reducing the disproportionate rates of HIV/AIDS within the African American community by ensuring treatment access to all populations.
Collapse
Affiliation(s)
- Samuel Okpaku
- Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee 37208, USA.
| | | | | | | | | | | |
Collapse
|
20
|
Rebholz C, Drainoni ML, Cabral H. Substance Use and Social Stability among At-Risk HIV-Infected Persons. JOURNAL OF DRUG ISSUES 2009. [DOI: 10.1177/002204260903900404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about how substance use patterns affect social stability among persons living with HIV/AIDS (PLWH). This manuscript examines associations, using survey data collected between 2003–2004, between substance use and social stability measures in 1,133 at-risk PLWH enrolled in 10 outreach programs across the US funded by the Health Resources and Services Administration. Substance use patterns were found to impact the social stability indicators of housing status, need for food, and income level. Effect varied by types and numbers of drugs used. These findings have important implications for policy and for planning effective program interventions for HIV-infected substance users.
Collapse
|
21
|
Perron BE, Mowbray OP, Glass JE, Delva J, Vaughn MG, Howard MO. Differences in service utilization and barriers among Blacks, Hispanics, and Whites with drug use disorders. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2009; 4:3. [PMID: 19284669 PMCID: PMC2660316 DOI: 10.1186/1747-597x-4-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 03/13/2009] [Indexed: 11/10/2022]
Abstract
Background Treatment for drug use disorders (DUD) can be effective, but only a small proportion of people with DUD seek or receive treatment. Research on racial and ethnic treatment differences and disparities remains unclear. Understanding racial and ethnic differences and disparities in drug treatment is necessary in order to develop a more effective referral system and to improve the accessibility of treatment. The purpose of the current study was to explore the role of race and ethnicity in service utilization. Methods Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), this study examined racial and ethnic differences in use of 14 types of treatment services for DUD and 27 different treatment barriers among persons who met lifetime criteria for a DUD. Multivariate logistic regression analyses were used to examine service utilization and barriers among the racial and ethnic groups, while adjusting for other sociodemographic and clinical variables. Results and discussion Among Blacks, Hispanics and Whites in the overall NESARC sample, approximately 10.5% met criteria for at least one lifetime drug use disorder. Approximately 16.2% of persons with a lifetime DUD received at least one type of service. Overall, this study indicated that Whites were less likely to report receiving help for drug-related problems than Blacks, Blacks used a greater number of different types of services, and no racial and ethnic differences were observed with respect to perceived barriers to drug treatment. However, by examining types of services separately, a complex picture of racial and ethnic differences emerges. Most notably, Whites were most likely to use professional services, whereas Blacks were most likely to use 12-step and clergy. The service use pattern of Hispanics most resembled that of Whites. Conclusion While structural barriers to accessing treatment were observed, broad-based educational programs and interventions that are appropriately targeted to racial and ethnic groups remains an important area for prevention and treatment.
Collapse
Affiliation(s)
- Brian E Perron
- University of Michigan, School of Social Work, 1080 S, University Avenue, Ann Arbor, MI 48109, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Homelessness, drug use and Hepatitis C: A complex problem explored within the context of social exclusion. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19:429-35. [DOI: 10.1016/j.drugpo.2007.09.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 09/05/2007] [Accepted: 09/07/2007] [Indexed: 02/06/2023]
|
23
|
Sexton RL, Carlson RG, Leukefeld CG, Booth BM. Barriers to formal drug abuse treatment in the rural south: a preliminary ethnographic assessment. J Psychoactive Drugs 2008; 40:121-9. [PMID: 18720660 DOI: 10.1080/02791072.2008.10400621] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This article describes barriers to obtaining drug abuse treatment in the rural South using qualitative interviews conducted with 86 illicit stimulant users recruited in rural Arkansas and Kentucky between 2003 and 2005. Fifty-nine (69.0%) of the interviewees had never entered drug abuse treatment. Sixteen (19.0%) participants reported current perceived need for treatment, while seven (8%) were ambivalent about seeking it. Interview data suggest five interrelated categories of barriers to accessing drug abuse treatment: (1) geographical, (2) organizational, (3) economic, (4) social, and (5) psychological. The study findings can inform further examination of rural treatment barriers and have important implications for developing strategies to overcome these obstacles.
Collapse
Affiliation(s)
- Rocky L Sexton
- Center for Interventions, Treatment and Addictions Research, Department of Community Health, Wright State University Boonshoft School of Medicine, Dayton, OH 45435, USA.
| | | | | | | |
Collapse
|
24
|
Neale J, sheard L, Tompkins CNE. Factors that help injecting drug users to access and benefit from services: A qualitative study. Subst Abuse Treat Prev Policy 2007; 2:31. [PMID: 17971204 PMCID: PMC2169215 DOI: 10.1186/1747-597x-2-31] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 10/30/2007] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND International research shows that injecting drug users (IDUs) can encounter many barriers when they try to access drug treatment and other services. However, the existing literature is mostly quantitative and does not consider the kinds of factors that injectors themselves identify as enabling them to access and benefit from services. Responding to this gap in knowledge, our paper explores IDUs' own suggestions for improving service engagement and their reports of other factors enabling them to seek help. METHODS Semi-structured qualitative interviews were conducted with 75 current illicit drug injectors in three geographically diverse areas of West Yorkshire, England. Recruitment was through needle exchange programmes, with additional snowball sampling to ensure inclusivity of gender, ethnicity and primary drug injected. Transcribed data were analysed thematically using Framework. RESULTS Although participants were often satisfied with current access to services, they made three broad suggestions for improving engagement. These were: providing more services (more providers and more forms of support); better operation of existing services (including better communication systems and more flexibility around individual needs); and staffing-related improvements (particularly, less judgemental and more understanding staff attitudes). Other factors identified as important enablers of help seeking were: having supporting relationships (particularly with family members); personal circumstances/life events (especially becoming a parent); and an injector's state of mind (such as feeling motivated and positive). CONCLUSION A range of practical suggestions for improving IDUs' access to drug treatment and other services are identified.
Collapse
Affiliation(s)
- Joanne Neale
- Professor of Public Health, Oxford Brookes University, Oxford, UK
| | - Laura sheard
- Research Fellow, Leeds West Primary Care Trust, Leeds, UK
| | | |
Collapse
|
25
|
Redko C, Rapp RC, Carlson RG. Pathways of Substance Users Linking (Or Not) With Treatment. JOURNAL OF DRUG ISSUES 2007; 37:597-618. [PMID: 18167518 PMCID: PMC2168035 DOI: 10.1177/002204260703700306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative paper describes different pathways substance users experience as they decide whether to link to treatment or not after being assessed in a centralized intake unit in a Midwestern city. The narratives of 16 participants who did not link with treatment were compared with the narratives of 20 participants who did. Narratives from both groups described similar themes that were experienced differently. Nonlinkers were characterized by pretreatment abstinence, a negative experience with previous treatment, little previous engagement in a treatment career, and meaningful social support coming from AA. Linkers were more likely to continue using drugs before treatment entry, yet they described more readiness for treatment and were more engaged in a treatment career. The treatment careers approach provides a broader framework for understanding linkage versus nonlinkage to treatment.
Collapse
Affiliation(s)
- Cristina Redko
- Ph.D., is a research scientist and ethnographer in the Center for Interventions, Treatment & Addictions Research in the Boonshoft School of Medicine of Wright State University. M.S.W., is an assistant professor in the Wright State University School of Medicine. Ph.D., is professor and director of the Center for Interventions, Treatment & Addictions Research at Wright State University
| | | | | |
Collapse
|