Review of the effects of self-stigma and perceived social stigma on the treatment-seeking decisions of individuals with drug- and alcohol-use disorders

Opioid prescription patterns and pain severity among patients with opioid use disorder and other substance use disorders: a mixed methods study

Objective

Pain management for patients with substance use disorders (SUDs) poses challenges, yet little is known about their pain severity perceptions. We conducted a mixed-methods study to understand numeric pain severity reporting among patients with SUD. We assessed how interactions between opioid prescribing and time, medications for opioid use disorder (MOUD), complementary medicine (CM), and outpatient SUD-related services (OS) predict differences in reported pain severity among patients with SUD.

Methods

We analyzed electronic health records (EHR) data, from 2003 to 2023, among the Oracle EHR Real-World Database, which comprised 141 US health systems from 50 states. We used longitudinal patient-reported numeric rating scale pain severity scores in linear mixed effects regressions to predict mean pain severity scores. We also conducted 2 focus-groups, from 2022 to 2023, with patients with SUD and SUD-treating clinicians aiming to explore pain severity reporting.

Results

Overall, predicted mean pain scores (95% confidence interval) were highest for patients with OUD (4.52 [4.51, 4.53]), lower for other patients with SUD (3.80 [3.79, 3.81]), and lowest for controls (3.28 [3.27, 3.29]) across all opioid prescription doses and durations. Complementary medicine use was associated with lower pain scores for all patients prescribed opioids. Pain scores were also lower for patients with OUD and SUD prescribed opioids and using OS, and for patients with OUD treated with MOUD and prescribed higher dose opioids. Focus-groups revealed pain reporting is influenced by anticipated clinician disbelief, treatment changes, and stigma.

Conclusion

These findings highlight the need to address pain within addiction treatment and further examine effective pain management interventions for this complex patient population.

Exploring the relationship between proactive e-alcohol therapy and symptoms of anxiety or/and depression: Post-hoc analyses from a randomized controlled trial

Background

Individuals with problematic alcohol use often face anxiety and depressive symptoms, which can hinder treatment engagement, compliance, and effectiveness. Psychosocial therapy through video conference (e-alcohol therapy) may reduce these barriers. We explored whether 1) anxiety or/and depressive symptoms modify the effect of proactive e-alcohol therapy on treatment initiation, compliance, and alcohol intake, 2) proactive e-alcohol therapy impacts anxiety or/and depressive symptoms compared to standard care.

Methods

Participants with problematic alcohol use were recruited online and randomly assigned to proactive e-alcohol therapy or standard care. Problematic alcohol use was defined by an 8+ score on the Alcohol Use Disorders Identification Test. Anxiety and depressive symptoms were measured using the Patient Health Questionnaire-4.

Results

356 individuals participated; 133 showed moderate-severe symptoms of anxiety and depression at baseline. There were no significant differences between individuals with and without moderate-severe anxiety or/and depressive symptoms in the effect of proactive e-alcohol therapy versus standard care on treatment initiation (3 mo: p = 0.64; 12 mo: p = 0.97), compliance (3 mo: p = 0.40; 12 mo: p = 0.58), or alcohol intake (3 mo: p = 0.86; 12 mo: p = 0.90). No significant differences were found in the proportion of participants with moderate-severe anxiety and depressive symptoms between the two intervention groups after 3 months (OR 0.6; 95 % CI 0.3 to 1.4; p = 0.27).

Conclusions

We found no evidence that anxiety or/and depressive symptoms modify the effect of proactive e-alcohol therapy on treatment initiation, compliance, or alcohol intake. Proactive e-alcohol therapy matched standard care in reducing anxiety or/and depressive symptoms over a 3-month follow-up.

Could Telling Parents About Substance Use Decrease Involvement in Crime of Substance Users?

INTRODUCTION

Substance use disorder and criminal behaviors are increasing all over the world day by day. Factors that affect the involvement in crime among people with substance use disorders need to be examined more. This research aims to investigate the protective factors of substance users' involvement in crime and clarify the importance of telling parents about their substance use.

METHOD

A total of 190 patients with substance use disorders were included. Patients were divided into two groups: those who told their families about their substance use (TP+) and those who did not tell (TP-). A sociodemographic data form, the short form of My Memories of Upbringing Scale for perceived parental attitudes, Experiences in Close Relationships Scale-Revised, and Emotional Autonomy Scale were used.

RESULTS

Our study found that people in the TP+group were less involved in crime than TP-. Telling rates increased proportionally when individuals' anxious attachment and individuation levels rose. In the TP+group, criminal history was correlated positively with substance use duration.

CONCLUSION

Telling their families that they are using substances can be a protective factor in itself against crime among drug users, especially in the early stages of addiction. Professionals in addiction psychiatry should encourage their patients to tell their substance use. Teaching and encouraging them to communicate with their relatives might play a key role for policymakers while dealing with substance use disorders and related outcomes.

Balancing Privacy, Trust, and Equity: Patient Perspectives on Substance Use Disorder Data Sharing

BACKGROUND

Sharing substance use disorder (SUD) data is essential for advancing equitable healthcare and improving outcomes for marginalized populations. However, concerns about privacy, stigma, and adherence to data privacy regulations often hinder effective data sharing. This study explores patient preferences and considerations related to sharing SUD-related medical records, with a focus on the sociocultural and systemic factors that shape their willingness to share.

METHODS

A total of 357 adult patients from four community-based clinics in Arizona participated in a cross-sectional electronic survey. The survey assessed sociodemographic factors, experiences of stigma (self-directed, anticipated, and provider-based), trust in healthcare providers, satisfaction with care, and willingness to share SUD data across various scenarios. Data were analyzed using descriptive statistics, Pearson correlations, and one-way ANOVA to uncover key associations.

RESULTS

Patients identified SUD history, diagnoses, and treatment information as particularly sensitive. Stigma was significantly correlated with increased sensitivity and reduced willingness to share data, especially with providers outside their primary facility (p < 0.001). In contrast, trust in providers and higher satisfaction with care were linked to greater willingness to share data with all providers (p < 0.01). Patients were more inclined to share SUD data during emergencies or for direct treatment purposes than for administrative or research applications (p < 0.001).

DISCUSSION

These findings underscore the ethical imperative to address stigma and foster trust to promote equitable SUD data sharing. Policies must empower patients with control over sensitive health information while ensuring cultural competence and fairness in care delivery. Ensuring that patients feel confident in how their data are used may encourage greater participation in health information exchange, ultimately supporting more effective and individualized SUD care.

What do patients with substance use disorders know about their medication? A cross-sectional interview-based study

Purpose

This study investigates the medication knowledge of patients with substance use disorders (SUDs) treated at a psychiatric clinic in northern Germany, aiming to identify gaps in understanding and to enhance patient safety, particularly concerning ATC group A drugs.

Setting

The study was conducted in the Department of Psychiatry, Social Psychiatry, and Psychotherapy at Hannover Medical School, Germany.

Design

A cross-sectional, interview-based study using a convenience sample of 100 patients was conducted between March 2023 and April 2024.

Participants

The cohort included patients with SUDs who had been hospitalized for at least 72 hours, regularly took at least one medication in addition to withdrawal drugs, and who displayed no cognitive impairments. Participants had a median age of 46.5 years; 62% were male.

Intervention

Patients were interviewed using a customized questionnaire addressing knowledge of drug name, indication, dosage, and frequency of application. The questionnaire also assessed the sources of medication knowledge and patient opinions on their medication regimen.

Primary and secondary outcome measures

The primary outcome was the average medication knowledge score (range 0-6). Secondary measures included differences in knowledge across drug groups, sources of information, and demographic influences.

Results

The median medication knowledge score was 3.8 out of 6. Knowledge was significantly lower for ATC group A drugs compared to groups B, C, and N (p < 0.001). No significant differences were observed between men and women nor between age groups. Hospital physicians were the primary information source for 40% of patients. Most participants (84%) considered their medication regimen adequate.

Conclusion

Patients with SUDs demonstrated suboptimal medication knowledge, particularly regarding ATC group A drugs. Future strategies should prioritize patient education and enhanced physician engagement to improve understanding and adherence, ultimately fostering better therapeutic outcomes.

Exploring reasons behind the initiation of and compliance with proactive alcohol e-therapy: A qualitative study

BACKGROUND

This paper is embedded in a randomized controlled trial that examined the effectiveness of psychosocial alcohol therapy delivered either via video conference (proactive alcohol e-therapy) or face-to-face (standard care). The trial demonstrated that proactive alcohol e-therapy increased treatment initiation and treatment compliance compared to standard care while achieving comparable reductions in alcohol intake among individuals with problematic alcohol use. In this study, we explored why participants initiated and complied with proactive alcohol e-therapy.

METHODS

A thematic analysis was completed based on ten semi-structured interviews with participants engaged in proactive alcohol e-therapy and observations of 21 therapy sessions.

RESULTS

Participants initiated proactive alcohol e-therapy because the recruitment process framed problematic alcohol use and alcohol treatment in a way that aligned with their self-image. The framing also helped alleviate the stigmatizing and prejudiced perceptions participants held about problematic alcohol use and treatment. Participants' treatment compliance relied on the flexibility of the online format, which allowed for seamless and discreet integration into daily life. Additionally, treatment compliance depended on the establishment of a trustful dialogue with the therapist and the participants' perception of therapy.

CONCLUSIONS

Effective communication was crucial in the decision-making process leading to treatment initiation. Treatment compliance was driven by the online format's capacity to meet individual preferences and needs and by a strong therapist-client alliance. These findings highlight the practical dynamics of proactive alcohol e-therapy and illustrate the value of qualitative research methods within the field of online alcohol treatment.

Alcohol use disorder among people diagnosed with tuberculosis in a large urban case-finding project in central Uganda: prevalence, associated factors and challenges to treatment adherence

BACKGROUND

Heavy consumption of alcohol increases the risk of developing active tuberculosis (TB), contributes to delayed diagnosis and affects adherence to treatment. Within a large urban case-finding project, we aimed to determine the prevalence of and factors associated with alcohol use disorder (AUD) and to understand the challenges that people with AUD face while seeking for TB services and adhering to TB treatment.

METHODS

We carried out an explanatory sequential study in two large urban districts in Uganda. We collected quantitative data on the prevalence of alcohol use disorder using the Cut, Annoyed, Guilty, Eye opener (CAGE) tool. We used a Poisson regression model with robust variance to examine factors associated with AUD. Both the crude and adjusted prevalence risk ratios with 95% confidence intervals were presented. We then conducted two focus group discussions with persons diagnosed with both TB and AUD. Focus group discussions (FGDs) were transcribed, data were analysed inductively and coded into themes using NVIVO version 12 software.

RESULTS

Out of 325 people with TB people interviewed, 62 (18.7% 95% confidence interval [CI] 18-31%) screened positive for AUD. Majority 82.3% (51/62) were male. Being male aPR 2.32 (95% CI 1.19, 4.49) and living in an urban area aOR 1.79 (95% CI: 1.10, 2.92) were significantly associated with a positive screen. Among people who screened positive for AUD, there was a tendency towards suboptimal TB treatment outcomes, although this did not reach significance aPR 1.65 (95% CI: 0.95, 2.85). Fourteen people (eight male and six female) who screened positive for AUD attended two FGDs. These respondents often did not disclose alcohol use during TB treatment and missed clinic refill appointments due to lack of transport fares to the clinic.

CONCLUSION

A significant proportion of people with TB screened positive for AUD but did not disclose alcohol use to their healthcare workers. These patients experienced several challenges while on TB treatment. Therefore, TB care programs need to design interventions that actively assess for AUD and in order to address related challenges.

Psychological Help-Seeking Among College Students: Applying the Multi-Theory Model of Health Behavior Change in Assessing Telehealth Use for Psychological Help-Seeking

Background

Due to the deleterious effects on psychological health and wellbeing spurred by the pandemic, utilization of telehealth-based care increased over the past few years. The rapid transition from in-person to telehealth-based health service delivery has yet to be fully understood. The aim of the current study was to examine telehealth use for psychological help-seeking among college students using the Multi-theory Model of health behavior change (MTM) as a theoretical framework.

Methods

A cross-sectional and survey-based study was conducted among students at a large US university (N = 356). Valid and reliable scales were used to measure domains of psychological distress and MTM constructs. Participants were grouped based on past 12-month utilization of telehealth for any mental, emotional, or substance use problems.

Results

Roughly 67% of the sample reported that they needed help dealing with psychological distress, and 56.1%,43.3%, and 38.7% screened positive for anxiety, depression, and suicidal ideation, respectively. Depression, anxiety, and suicidal ideation were positively associated with past 12-month telehealth-based help-seeking. Past 12-month telehealth users reported greater advantages, confidence, and emotion direction toward telehealth-based psychological help-seeking than their counterparts. Participants also perceived higher exhibition of behavioral skills and greater social support to aid help-seeking than their counterparts. Advantages and disadvantages as well as behavioral confidence predicted intentions for telehealth-based help-seeking after controlling for anxiety, depression, suicidal ideation, perceived stigma, and perceived need for help among both groups.

Conclusion

The MTM theoretical framework is a valuable framework for predicting telehealth-based psychological help-seeking among college students. Such framework can be used to design and implement mental health programing.

Exploring experiences of talk therapies among gay and bisexual men seeking to reduce or abstain from using crystal methamphetamine in the context of chemsex

INTRODUCTION

Some gay and bisexual men who have sex with men (GBMSM) who use drugs to enhance sex (chemsex/party and play) may experience harms and seek talk therapies. GBMSM who practice chemsex may not access drug services because of anticipated stigma and the perception that these services lack chemsex expertise. Barriers to services are documented, however, little is known about the service experiences of chemsex engaged GBMSM.

METHODS

Semi-structured interviews were conducted with 24 participants reporting current practice of sexualised use of methamphetamine and/or gamma hydroxybutyrate. Interviews explored experiences of counselling and psychology services, participant's treatment goals and challenges. Data were transcribed verbatim and analysed in NVIVO14 with a qualitative description methodology.

RESULTS

Most in our study sought to reduce the frequency of methamphetamine use and used methamphetamine only in sexual contexts. When engaging with counsellors and psychologists in alcohol and other drug or mental health services for the general adult population, most censored the sexual drivers and types of sexual behaviours incumbent in their methamphetamine use. Participants' reliance on drugs for sex was spoken about as a major barrier to reducing methamphetamine. Sexual self-censorship within services inhibited participants' abilities to access meaningful support and achieve treatment goals.

DISCUSSION AND CONCLUSIONS

Counsellor and psychologists working with GBMSM around drug use, must ask about context of drug use and sex. Training and supervision around sexual therapies for those working alongside GBMSM who practice chemsex may be beneficial. Research on treatment approaches to support the sexual wellbeing of people who practice chemsex is required.

Substance Use Disorder Stigma and Professional Decision Making Among Pre-Professional Healthcare Trainees

Provider stigma toward people who have substance use disorders (SUDs) may be a barrier to effective treatment delivery. The purpose of this study was to measure provider stigma among healthcare professionals-in-training and determine whether stigma levels were associated with professional decision making. A sample of 240 participants were recruited from the following academic programs at a large university in the southeastern United States: Nursing, Social Work, Counseling, Marriage and Family Therapy, and Psychology. Through an online, anonymous survey, provider stigma and other constructs were measured. The participants were also asked to make two hypothetical professional decisions: one regarding their choice to provide treatment for an SUD patient and the other regarding their likelihood of attending a professional development event (i.e., conference session) on the topic of SUDs. Results showed that self-reported stigma toward patients with SUDs was associated with a reduced likelihood of choosing to provide treatment for a patient with SUD (compared to patients with other conditions) and a reduced likelihood of attending SUD training at an upcoming conference (compared to other conference topics). Results have potential implications for the development of training programs for pre-professional healthcare trainees.

Retrospective case-control analysis of the infectious complications of retained broken needles in people who inject drugs

Retained broken needles (RBNs) in patients is a potentially underreported complication of intravenous drug use (IVDU) in people who inject drugs. Identification of RBNs poses a challenge for radiologists and clinicians due to subtle appearance on imaging and the complexities of patient presentations. A single-center case-control study was performed between January 1, 2021, and December 31, 2021. The cases included all patients with a history of IVDU who presented to the emergency department (ED) with RBNs. Data collected on the study population included RBN location and size, complications, and imaging modality. A control group of 2:1 matched on age, gender, and race/ethnicity with the cases was generated from patients with a history of IVDU from the same time period who had no RBNs. A total of 3920 total patients presented to ED with a history of IVDU and 70 patients were found to have RBN (1.8%). RBNs were most observed in the foot/ankle (32.9%) forearm (18.6%), and neck (17.1%). RBNs were found to be incidental in 82.9% (58 out of 70) of patients. Radiography located needle fragments (55.7%) slightly more often than CT (44.3%). Overall, among all the cases and controls combined, 33.8% had positive blood cultures. In the group of patients with a RBN, 47.1% presented with positive bacterial blood cultures during the hospital admission, whereas the group without an RBN showed 27.1% (P = .004). The RBN group showed significantly higher rates of abscess (72.9% vs 48.6%), cellulitis (70.0% vs 46.4%), and osteomyelitis (37.1% vs 13.6%) than the non-RBN group (all P ≤ .001). This study suggests that RBNs are likely underreported and patients with RBNs are at an increased risk of infectious complications. Increasing the awareness and refining our understanding of RBNs is crucial to mitigating these complications.

Misconceptions, prejudice and social distance towards people with alcohol use disorders in China

PURPOSE

Research from Western societies indicates pervasive public stigma against people with alcohol use disorders (AUDs). However, there is a lack of knowledge about the interactions between different components of stigma and their contribution to discriminatory behaviour towards individuals with AUDs within the Chinese cultural context. The aim of the present study was therefore to investigate the relationships of (mis-)conceptions, stereotypes, emotional reactions, perceived public stigma and their contribution to the desire for social distance among the Chinese adults.

METHODS

(Mis-)conceptions, stereotypes, emotional responses, willingness to help and avoid, perceived stigma, and the desire for social distance from individuals with AUDs were assessed via a cross-sectional online survey with a sample of 1,100 adults from the Chinese population.

RESULTS

Three-fourth of the participants recognised AUDs as mental illnesses, though 70% of the sample did not support health insurance coverage for the treatment of AUDs. A stronger desire for social distance was associated with greater recognition of alcohol use disorders as mental illnesses, heightened perceptions of dangerousness and personal responsibility, increased fear, and more willingness to avoid and withhold help, controlling for age, gender, education, employment, mental health service utilisation, and alcohol consumption. Fear fully mediated the effects of perceptions of dangerousness and responsibility on the desire for social distance.

CONCLUSIONS

To improve social integration for individuals with AUDs in China, culturally tailored anti-stigma programmes are needed to reduce negative attitudes and discriminatory behaviours among the Chinese population.

Treatment rates and delays for mental and substance use disorders: results from the Australian National Survey of Mental Health and Wellbeing

AIMS

Prompt initial contact with a treatment provider is a critical first step in seeking help for a mental or substance use disorders (SUDs). The aim of the current study was to provide estimates of patterns and predictors of delay in making initial treatment contact based on the recently completed Australian National Survey of Mental Health and Wellbeing.

METHODS

Data came a nationally representative epidemiological survey of n = 15,893 Australians. Measures included DSM-IV lifetime diagnoses of mood (MD), anxiety (AD) and SUDs; age of disorder onset; and age of first treatment contact. Correlates of treatment delay were examined.

RESULTS

SUDs exhibited the lowest lifetime treatment rate (27%), compared to MD (94%) and ADs (85%). Individuals with AD experienced the longest delay in seeking treatment (Mdn = 11 years), followed by those with SUDs (Mdn = 8 years) and MDs (Mdn = 3 years). Females had higher odds of seeking treatment for MD and AD but lower odds for SUDs. Recent birth cohorts showed increased treatment seeking across disorders, and higher education was associated with increased treatment seeking for MD and AD. Age of onset, country of birth and co-occurring disorders had mixed associations with treatment seeking.

CONCLUSIONS

The study reveals stark disparities in treatment-seeking behaviour and delays across mental and substance use disorders, with a pronounced underutilization of services for SUDs. Additionally, attention should be directed towards early intervention for individuals with earlier symptom onset, those from earlier cohorts and those with co-occurring SUDs.

Teaching Knowledge and Empathy in Substance Use Disorder Through Enriched Education in the Neurobiology of Addiction: A Narrative Review on Addiction Education in Professional Schools

BACKGROUND

Addiction is a devastating chronic disease requiring significant resources and attention. Healthcare professionals have noted struggles in caring for patients with substance use disorder (SUD) due to stigma, perceived difficulties in dealing with patients, and issues with treatment compliance. Challenges in dealing with individuals with SUD may stem from an inadequate understanding of the disease and consequent misconceptions about patient behaviors. The type and extent of addiction education affect the depth of understanding of SUD and shape attitudes toward patients. In this review, we explore aspects of addiction education including examining curricular guidelines and educational strategies, especially regarding the neurobiology of addiction.

METHODS

We conducted a narrative review using online databases and search engines to identify studies related to addiction/SUD education with emphasis on the type and extent of neurobiological content.

RESULTS

Studies examining addiction education document deficiencies that may contribute to insufficiencies in SUD treatment and disrespectful treatment of individuals with SUD. There is also a lack of detail regarding the extent of the neurobiology of addiction education in professional core courses and curricular guidelines. Implementing a more detailed approach to addiction education with more comprehensive neurobiology is discussed along with strategies to motivate students to learn and appreciate these complex details.

CONCLUSIONS

While there are many aspects of addiction education, a solid foundation in the neurobiological mechanisms of addiction is important to establish an appreciation for the disease nature of addiction and the resulting behaviors of the individual. Teaching beyond the rewarding nature of addiction is essential to enable students to comprehend how the activation of survival stress systems and compromised decision-making affects the behavior of individuals with SUD. A more comprehensive understanding of addiction fosters more respect for individuals with SUD and creates potential for more opportunities for effective treatment.

Working Elements in Interventions to Reduce Problematic Alcohol Use According to Older Adults: A Realist Evaluation

This study explored working elements (E) and mechanisms (M) in interventions within different contexts (C), contributing to the outcome (O) of reducing (problematic) alcohol use among older adults. Guided by a realist evaluation approach, interviews with older adults participating in interventions (N = 20) were conducted. In different contexts, several working elements were identified: (1) receiving information about alcohol and health (risks); (2) paying attention to abstinence; (3) being in contact with and receiving support from peers and relatives; (4) maintaining contact with a practitioner or peer/buddy who is always or flexibly available for communication; and (5) learning to manage drinking behavior, and one important mechanism was identified: motivation. From the older adults' perspectives, there was a need to focus on social contact and support from peers and relatives, tracking and reflection, and motivation to reduce problematic alcohol use.

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).

Characterization of People Living with HIV Who Inject Drugs in Mexico City: Importance for Transmission and Detection

People who inject drugs (PWID) face a heightened risk of acquiring/transmitting HIV, enhanced by stigma and limited health care access. In Mexico, studies on PWID have focused on the north of the country. This study aimed to delineate characteristics of PWID living with HIV in Mexico City, identify profiles based on the substance injected, and evaluate variables associated with forming transmission clusters. A cross-sectional study was conducted with data from 2019 to 2023. Participants completed a questionnaire on sociodemographic, clinical, and behavioral variables. Bivariate and multi-variate logistic regression analyses were made. Among PWID, 96.3% were male (n = 437), of which 90.1% were men who have sex with men, 1.5% were cisgender females (n = 7), and 2.2% were transgender females (n = 10). PWID were more likely to use drugs during sex (adjusted odds ratio [aOR] = 3.3, 95% confidence interval [CI]: 1.7-6.4, p < 0.001), have more sexually transmitted diseases (aOR = 1.7, 95% CI: 1.1-2.9, p = 0.035), and have less condom use (aOR = 0.5, 95% CI: 0.3-0.8, p = 0.002). The most frequently injected substance was crystal meth, and those who injected it were more likely to have syphilis (aOR = 2.9, 95% CI: 1.2-7.1, p = 0.021), use Grindr (aOR = 3.6, 95% CI: 1.5-8.9, p < 0.001), and engage in high-risk practices (aOR = 6.9, 95% CI: 2.1-22.7, p < 0.001) in the last 3 months. Those under 25 years (p = 0.002), recently infected (p < 0.001), and who practiced insertive anal sex (p < 0.001) were more likely to be part of a cluster. These findings, and the increasing use of crystal meth, underscore the critical need to implement targeted risk-reduction strategies for PWID living with HIV and to design interventions responsive to specific profiles associated with different substances, taking into account not only their risk practices but also protective behaviors such as HIV testing.

Decrease in provider stigma is associated with improved quality health indicators among individuals receiving methadone in primary care centers in Ukraine

INTRODUCTION

People who inject drugs experience poor health and social outcomes which improve with opioid agonist therapies like methadone, yet provider stigma may influence healthcare utilization. In Ukraine, integrating methadone into primary care centers (PCCs) provides an opportunity to examine provider stigma and its impact on patient outcomes.

METHODS

This sub-analysis included patients randomized to receive methadone in PCCs as part of an implementation trial in which the control group received methadone in specialty addiction clinics in Ukraine. Methadone integration in PCCs was supported through continuous tele-education for providers. Provider stigma towards people who inject drugs, methadone, and attitudes towards evidence-based practices were assessed at baseline, 12, and 24 months using standardized scales (range 1-10). Patient-level outcomes were measured bi-annually over 24 months using a quality health indicator (QHI) score, a percentage of guideline-concordant primary and specialty health services accessed. Linear mixed-effects models examined the changes in provider stigma and attitudes, and the association of these measures with patient outcomes.

RESULTS

The sample included 583 patients and the 112 providers in 24 clinics. Provider fear and stereotypes toward people who inject drugs improved significantly, by 0.6 (95 % CI 0.2-1.1) and 0.4 points (95 % CI 0.1-0.8), respectively, as did preference for methadone over abstinence-based treatment (0.7 points, 95 % CI 0.2-1.1). A 1-point improvement in provider prejudice correlated with a 7.0-point increase (95 % CI: 1.1-13.0) in patient primary care QHI scores at 12 months, while improved attitudes towards evidence-based practices were associated with an 8.3-point increase (95 % CI: 1.1-13.0). Preference for methadone maintenance over abstinence was associated with a 3.7-point increase (95 % CI: 0.6-6.7) in specialty care QHI scores at 12 months, and reduced stereotypes were associated with a 10.9-point increase (95 % CI: 1.2-20.7) at 24 months.

CONCLUSIONS

Integrating methadone into PCCs with the support of provider tele-education may reduce provider stigma, particularly fear and stereotypes, toward people who inject drugs and methadone maintenance. Reducing provider stigma has the potential to improve patient outcomes through increased access to preventive care and screenings.

Certified peer recovery support specialists and substance use related emergency department visits: A mixed methods study of the patient experience

INTRODUCTION

Emergency department (ED) peer-delivered interventions have been implemented across the country to improve outcomes for people who use drugs. In this study we describe what elements patients believe led to a positive interaction with a certified peer recovery support specialist (CPRSS) in the ED and discuss implications when those elements were missing.

METHODS

This is a qualitatively driven mixed methods study embedded within a larger longitudinal study. Using a close and open-ended question interview guide, we interviewed 26 participants from 2018 to 2023 who met with a CPRSS in a Nevada ED for a substance use related concern. Interviews were recorded and transcribed verbatim. Thematic analysis was used to code the transcripts and generate themes. Quantitative data (satisfaction, therapeutic alliance, and social support) were analyzed using student-t, Fisher's exact, and one-way ANOVA tests.

RESULTS

Participants described numerous elements that they believed contributed to being satisfied with their CPRSS interaction, which we grouped into three categories: 1) how the CPRSS interaction felt, 2) how the CPRSS services were delivered, and 3) patient factors that influenced the interaction with a CPRSS. Elements that contributed to their satisfaction, including whether the CPRSS adapted to their current circumstances, if they received personalized referrals, and how their own mental and physical state impacted their receptivity to services.

CONCLUSIONS

Our findings highlight areas to optimize implementation and increase program uptake for future ED-based CPRSS-delivered interventions, including training CPRSS in the philosophy of harm reduction, following up with the patient post-ED, and tailoring services to the patients' immediate needs.

Exploring the potential of Self-Management and Recovery Training (SMART Recovery) mutual-help groups for supporting people who use methamphetamine: A qualitative study examining participant experience of initiation and engagement

INTRODUCTION

Improving support options for people who use methamphetamine is of critical national and global importance. The role of mutual-help groups within the treatment-seeking journey of people who use methamphetamine is unclear. Self-Management and Recovery Training ('SMART Recovery') mutual-help groups are led by a trained facilitator and support participants to work on individual goals, including, but not limited to abstinence. This study examined how people who use methamphetamine came to be involved in SMART Recovery mutual-help groups and factors associated with engagement.

METHODS

A sample of Australian SMART Recovery participants who self-reported using methamphetamine in the preceding 12-months (n = 18) discussed their history of substance use and experience of service provision in a semi-structured telephone interview. Interviews were audio-recorded, transcribed, and analysed using iterative categorization.

RESULTS

Participant initiation of SMART Recovery groups was described across two themes: i) delayed attendance and ii) use as an adjunct to other services. Factors associated with engagement were discussed in terms of: i) the 'fit' of SMART Recovery mutual-help groups; ii) coping and tolerance of discomfort; iii) the power of shared lived experience; iv) choice and autonomy; and v) short-term goal setting supports self-efficacy and the possibility of change.

DISCUSSION AND CONCLUSIONS

SMART Recovery mutual-help groups show promise for engaging people who use methamphetamine. There is a clear need to improve awareness of mutual-help group options amongst service users, providers and the general community. Offering choice over mutual-help groups may help to engage people earlier and support improved linkage between services.

Effectiveness of Nurse-led Brief Intervention to Reduce the Risky Use of Alcohol and Tobacco Use Among Older Adults: Results of a Pilot Randomized Controlled Trial from India

Background

India has witnessed a gradual increase in substance use among the elderly, driven by the country's aging population and evolving demographic trends. There remains a lack of scientific foundation regarding the efficacy of brief intervention among older adults in the context of low- and middle-income countries. The current study explored the effectiveness of nurse-led brief intervention to reduce risky substance use patterns among the elderly in the Indian context.

Methods

The present study is a pilot randomized trial with assessments conducted before and after the intervention at 4-week intervals. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to detect changes in risky substance use, and the intervention was based on the ASSIST Brief Intervention Protocol. The study setting was a government-funded elderly citizen club, which was conveniently selected.

Results

Out of the 80 contacted participants, 60 subjects were enrolled, evenly divided between intervention and control groups. The mean age of the sample was 69.80 years (SD = 4.2). Although there was some difference in post-follow-up scores, we did not observe a significant benefit for the brief intervention in reducing risky substance use among the elderly in this setting (P > .05).

Conclusion

The study demonstrated a reduction in risky substance use patterns among the elderly population in both the intervention and control groups. Future trials should adopt rigorous methodological approaches to provide robust clinical evidence for implementing similar interventions aimed at enhancing the well-being of elderly individuals in this setting.

Consuming and Thinking About Nangs: A Survey of Nitrous Oxide Use, Knowledge, Attitudes and Perceptions in Aotearoa New Zealand

Non-medical use of nitrous oxide (N2O) is becoming increasingly popular globally, yet little data exists regarding N2O in Aotearoa New Zealand. We aimed to explore patterns of use and harm in those who consume N2O in Aotearoa, and related knowledge, perceptions and attitudes of those with and without N2O experience. A convenience sample of people with N2O experience (n = 466) and without (n = 510) completed an online survey about N2O. Most with N2O experience reported infrequent and low-dose consumption. Harm reduction behaviors were utilized by most consumers, and reports of adverse effects were relatively low. Self-reported acute or chronic harm (primarily psychological) was reported by only 5.8% of the N2O sample, whilst 9.2% reported ever experiencing persistent numbness (5.2% in the past 12 months). Self-reported knowledge about N2O varied and was greater in those with N2O experience. N2O knowledge was generally poor, although more accurate in those with N2O experience. Attitudes generally differed between those with and without N2O experience, and perceived harmfulness and experience significantly contributed to attitudes regarding N2O legality. Findings underscore the relative safety of N2O when used recreationally, but also highlight the need for greater drug education around potential risks of N2O use and harm reduction.

Alcohol use among populations with autism spectrum disorder: narrative systematic review

BACKGROUND

Alcohol use in autism spectrum disorder (ASD) is under-researched. Previous reviews have explored substance use as a whole, but this neglects individual characteristics unique to different substances. Alcohol use in non-clinical samples is associated with diverse responses. To advance practice and policy, an improved understanding of alcohol use among people with ASD is crucial to meet individual needs.

AIMS

This was a narrative systematic review of the current literature on the association between alcohol use and ASD, focusing on aetiology (biological, psychological, social and environmental risk factors) and implications (consequences and protective factors) of alcohol use in autistic populations who utilise clinical services. We sought to identify priority research questions and offer policy and practice recommendations.

METHOD

PROSPERO Registration: CRD42023430291. The search was conducted across five databases: CINAHL, EMBASE, MEDLINE, PsychINFO and Global Health. Included studies explored alcohol use and ASD within clinical samples.

RESULTS

A total of 22 studies was included in the final review. The pooled prevalence of alcohol use disorder in ASD was 1.6% and 16.1% in large population registers and clinical settings, respectively. Four components were identified as possible aetiological risk factors: age, co-occurring conditions, gender and genetics. We identified ten implications for co-occurring alcohol use disorder in ASD, summarised as a concept map.

CONCLUSION

Emerging trends in the literature suggest direction and principles for research and practice. Future studies should use a standardised methodological approach, including psychometrically validated instruments and representative samples, to inform policy and improve the experience for autistic populations with co-occurring alcohol use.

Impact of substance type and patient characteristics on the choice of treatment setting for substance use disorder in Belgium

BACKGROUND

Specialised addiction treatment centers (SAC) and general mental health centers (GMHC) both offer care to people with substance use disorders (SUD) in Belgium, but these sectors often operate in parallel, with little collaboration. This fragmented system may lead to inefficiencies, particularly in the treatment of individuals with dual diagnoses. Despite the recognized challenges, there is limited understanding of the factors that influence whether patients with SUD are treated in SAC or GMHC.

OBJECTIVES

This observational study has two main objectives: METHODS: The study used routinely collected data from treatment centers in Belgium from 2019 (Belgian Treatment Demand Indicator). Logistic regression evaluated the weight of drug use and sociodemographic variables for people entering treatment for SUD for the first time (n = 8322). A random forest algorithm was used to study all patients' orientation toward both sectors, across all treatment episodes (n = 29,658).

RESULTS

The study found that the primary substance significantly influences sector choice. Patients using illicit substances like cannabis, opiates, cocaine, and stimulants are 6-12 times more likely to be treated in an SAC than those using alcohol. Factors such as income source and referral source (e.g. self-referral, general practitioner, etc) also significantly impact patient orientation.

CONCLUSION

These findings highlight the need for better integration between SAC and GMHC to adequately address the complex needs of people with SUD, especially with dual diagnosis.

Global, regional, and national trends in drug use disorder mortality rates across 73 countries from 1990 to 2021, with projections up to 2040: a global time-series analysis and modelling study

Background

Drug use disorder (DUD) poses a major public health crisis globally, necessitating immediate attention to global trends and future projections to develop effective health policies and interventions. Thus, we aimed to estimate the global trends in DUD mortality rates from 1990 to 2021 and future projections of DUD deaths until 2040 across 73 countries.

Methods

In this time-series analysis and modelling study, we investigated the global trends in DUD mortality rates from 1990 to 2021 using the WHO Mortality Database and forecasted future trends through 2040. Global trend analysis was analysed using a locally weighted scatter plot smoother (LOESS) curve, and future projections were calculated based on a Bayesian age-period-cohort analysis. In addition, we performed a decomposition analysis to identify the variations in DUD deaths, specifically examining factors such as population growth, ageing, and epidemiological changes.

Findings

Of the 73 countries included in the analysis of DUD mortality, 45 were high-income countries (HICs), and 28 were low to middle-income countries (LMICs). The LOESS estimates of the global DUD mortality rate were 1.84 deaths per 1,000,000 people (95% CI, -0.44 to 4.12) in 1990 and 13.09 deaths per 1,000,000 people (95% CI, 10.74-15.43) in 2021. Notably, HICs showed a significant increase in DUD mortality from 1.43 deaths per 1,000,000 people (95% CI, -1.55 to 4.42) in 1990 to 17.19 deaths per 1,000,000 people (95% CI, 13.84-20.53) in 2021. A significant increase in DUD mortality was observed among individuals aged 25-64 and males. Our analysis also identified associations between DUD mortality rates and several log-transformed parameters, including Human Development Index (β, 14.92; p < 0.0001), Socio-demographic Index (β, 11.80; p < 0.0001), reverse Gender Gap Index (β, -12.02; p < 0.0001), and Gini coefficient (β, -1.84; p < 0.0001). From 1990 to 2021, the increase in the number of DUD deaths globally can be attributed to two prominent factors: epidemiological change and population growth. In HICs, the impacts of epidemiological changes for increasing DUD mortality rates were particularly prominent compared to other factors. In the Bayesian age-period-cohort models, the predicted number of global DUD deaths up to 2040 were estimated to increase from 25.95 deaths per 1,000,000 people (95% credible interval [CrI], 24.72-27.28) in 2021 to 38.45 (95% CrI, 30.48-49.33) in 2030, and 42.43 (95% CrI, 23.67-77.77) in 2040.

Interpretation

An increasing trend in global DUD mortality was observed from 1990 to 2021, especially in HICs. Future DUD deaths were also predicted to increase until 2040 at the global level. Therefore, these findings suggest urgent and proactive strategies for DUD to reduce the mortality rates related to DUD are needed. However, further prospective research that accounts for potential confounding factors, such as socioeconomic variables and the quality of reporting data from individual countries, is imperative for more accurate estimation.

Funding

National Research Foundation and Ministry of Science and ICT of South Korea.

Mental Illness Stigma in Black, Latina/o, and Asian Americans

Mental illness stigma has significant psychiatric consequences and can impede mental health treatment seeking, especially among racial minority groups; who are understudied in stigma research and experience striking treatment disparities. Guided by a novel empirical model of racial minority stigma and treatment seeking, this study investigated stigma and its effects on treatment seeking in Black, Latina/o, and Asian American adults. Data were collected via national panel survey from 613 Black, Latina/o, and Asian American adults. Perceptions of mental illness including seriousness, treatability, causal attributions, desired social distancing, and perceived dangerousness were assessed. Data were analyzed and compared with a nationally representative sample of the U.S. public from the 2018 General Social Survey. Minority participants exhibited stronger mental illness stigma than the U.S. public, with Black, Latina/o, and Asian American participants largely perceiving mental illness as less serious, less treatable, and desiring greater social distance from individuals with major depression, who were perceived as potentially dangerous. Notably, different stigma components significantly associated with willingness to seek treatment differently across Black, Latina/o, and Asian American participants. Overall, study findings indicate that mental illness stigma is strong and associates with treatment seeking in Black, Latina/o, and Asian Americans, suggesting a need to develop culturally tailored interventions to reduce stigma and associated treatment utilization disparities in these underserved minority groups.

Incarceration history and HIV testing among people who inject drugs in the Boston metro area: a pooled cross-sectional study

Background

The persistent incidence of HIV among people who inject drugs (PWID) underscores the urgency for HIV prevention efforts to end the HIV epidemic. Little is known about the role carceral settings play as touchpoints for HIV testing in this population.

Methods

Secondary analysis of cross-sectional survey data of PWID in the Boston metro area from the 2015 and 2018 cycles of the National HIV Behavioral Surveillance (NHBS). Among self-reported HIV-negative participants, we examined incarceration and HIV testing histories and used a multivariable modified Poisson regression model to evaluate the association between incarceration history (main exposure) and past-year HIV testing (primary outcome).

Results

Among 957 participants, average age was 38.9 (SD 11.1) years, 70.1% were male, 15.2% were Hispanic (of any race), 8.4% were non-Hispanic Black, and 68.1% were non-Hispanic White. Regarding incarceration experiences, 43.5% of participants reported past-year incarceration, and 41.8% reported a history of incarceration but only prior to the past year. Among those with past-year incarceration, 23.4% said their last HIV test was done at a jail or prison. Adjusting for other characteristics, compared to no incarceration history, past-year incarceration (PR 1.39; 95% CI: 1.29, 1.49) and incarceration prior to the the past year (PR 1.19; 95%CI: 1.02, 1.38) were both associated with a greater prevalence of past-year HIV testing.

Conclusions

Among PWID, incarceration was very common and was a substantial source of HIV testing. However, more testing is still needed-in both community and carceral settings-to reach optimal testing rates in this key population.

Alcohol treatment preferences and the acceptability of virtual reality therapy for treating alcohol misuse in adult drinkers

Alcohol misuse affects a large part of the population worldwide, with high relapse rates reported even post-treatment. Treatments are also not always available, for example during the COVID-19 pandemic when social distancing measures affected the availability of in-person approaches. Novel treatments like Virtual Reality Therapy (VRT), delivered via a standard VR headset or a mobile device, may offer a flexible alternative for reducing drinking and assisting relapse prevention, but little is known about their acceptability. We therefore explored the acceptability of VRT alongside the treatment preferences of adult drinkers in an online survey. Participants were asked to consider and rank order a range of treatments typically offered by healthcare services alongside standard and mobile VRT in order to determine their relative preferences. Acceptability of each treatment was also established. Additional questions addressed potential predictors of VRT's acceptability including familiarity with each treatment option presented, prior experience of VR, hazardous drinking, perceived stigma, treatment uptake attitudes, gender, ethnicity, and mental health. Of 259 participants, more than half (52.9%) were drinking at hazardous levels. The majority of respondents (86.9%) expressed a preference for in-person treatments. Cognitive Behavioral Therapy, Counseling, and 12-Step Facilitation Therapy were considered the most acceptable treatments, whereas VRT, and particularly mobile VRT, were perceived as less acceptable than traditional treatments. Treatment familiarity and preferences, prior VR experience, mental health, treatment uptake attitudes, and perceived stigma were all associated with the acceptability of VRT. Psychoeducation and familiarization processes in delivery protocols, and in-person delivery of VRT, could increase the acceptability of VRT, particularly for people who are not regular technology users, or who require concurrent mental health support.

Examining naloxone access and interest in secondary naloxone distribution on an American Indian Reservation in the Northern Midwest of the United States

Background

Indigenous communities in the United States experience disproportionate rates of overdose morbidity and mortality due to a range of historical traumas and ongoing oppression. Limited health and harm reduction service access on some Tribal lands exacerbate these challenges. To date, little is known about naloxone access on tribal reservation lands.

Methods

We used cross-sectional survey data from community members on the reservation lands of a northern Midwest Tribe in the United States. We explored the prevalence and correlates of recent (past 6-month) naloxone receipt and interest in secondary naloxone distribution among all participants and people who used drugs (PWUD) recently. Correlates included sociodemographics, cultural identity and spirituality, witnessing overdoses, stigma, and drug use characteristics.

Results

Among 227 Indigenous participants, the average age was 45, 62 % were women, 53 % were single, 29 % were not working, 29 % had experienced recent hunger, and 8 % considered themselves homeless. 91 % said that Indigenous spiritual values were important to them. Sixteen percent had witnessed a recent non-fatal overdose, and 6 % had witnessed a fatal one. Twenty-four percent of the overall sample had recently received naloxone, and 40 % of PWUD had received it. Witnessing both fatal (p<0.001) and nonfatal overdoses (p=0.001) were associated with receiving naloxone. Further, 63 % of participants were willing to distribute naloxone.

Conclusions

Innovative strategies to expand naloxone access that are culturally relevant and responsive are needed in Indigenous communities. Cultural connectedness and shared identity are key strengths of Indigenous communities that can potentially be leveraged to implement secondary naloxone distribution programs.

Self-stigma in alcohol dependence scale: development and validity of the short form

BACKGROUND

Self-stigma is associated with low self-esteem, high shame and reduced drinking-refusal self-efficacy in people with alcohol use disorder (AUD). The Self-Stigma in Alcohol-Dependence Scale-Short Form (SSAD-SF) was designed to enable a brief, but valid assessment of AUD self-stigma.

METHODS

We reduced the 64-item SSAD, originally derived from 16 stereotypes towards people with AUD, by removing the most offensive items based on perspectives of people with lived experience. The newly created scale was then assessed and validated in a cross-sectional study involving 156 people reporting alcohol issues in various treatment settings.

RESULTS

The 20-item SSAD-SF includes five stereotypes, with good internal consistency for each subscale and the overall scale. It reflects the four-stage progressive model of self-stigmatization with decreasing scores over the stages awareness of stereotypes, agreement with stereotypes, self-application of stereotypes, and harmful consequences for self-esteem, and highest correlations between adjacent stages. The subscales apply and harm were associated with internalized stigma, shame, reduced self-esteem, and lower drinking-refusal self-efficacy, as supported by multivariate regression models.

DISCUSSION

The SSAD-SF is a valid instrument for measuring the process of self-stigmatization in people with AUD. Self-stigma is a consistent predictor of reduced self-esteem, higher shame and lower drinking-refusal self-efficacy in people with AUD. We discuss merits of the progressive model for understanding and addressing self-stigma in AUD.

Influence of inpatient withdrawal treatment on drug safety in alcohol use disorder - a quasi-experimental pre-post study

OBJECTIVE

Most patients with alcohol use disorder (AUD) regularly take medication. Alcohol interacts negatively with many commonly prescribed medications. Little is known about whether the risk of potential alcohol-medication and drug-drug interactions increases or decreases in patients with AUD during inpatient withdrawal treatment. The aim of our study was to determine the prevalence and characteristics of potential alcohol-medication and drug-drug interactions in patients with AUD before and after withdrawal treatment in an addiction unit.

DESIGN

Prospective monocentric quasi-experimental pre-post study.

METHODS

Medication records before and after withdrawal treatment were analyzed and screened for potential alcohol-medication (pAMI) and drug-drug interactions (pDDI) using the drugs.com classification and the AiDKlinik® electronic interaction program, respectively.

RESULTS

We enrolled 153 patients with AUD who were treated in an addiction unit of a university hospital in Germany. Of these, 67.3% experienced at least one pAMI before and 91.5% after withdrawal treatment. In total, there were 278 pAMIs classified as "mild," "moderate," or "severe" before and 370 pAMIs after withdrawal treatment. Additionally, there were 76 pDDIs classified as "moderate," "severe," or "contraindicated combinations" both before and after withdrawal treatment.

CONCLUSION

The risk of exposure to pAMIs and pDDIs increases during inpatient withdrawal treatment in patients with AUD. Improvements in the quality of prescribing should particularly focus on the use of antihypertensives and opioids.

Making sense of drug use and dependence-A scoping review of mass media interventions intended to reduce stigma towards people who use drugs

BACKGROUND

People who use drugs face entrenched stigma, which fosters shame, restricts service access, and exacerbates inequalities. The use of mass media in anti-stigma interventions offers an opportunity to challenge stigmatising attitudes at scale. There are, however, inconsistencies in messaging approaches used in mass media anti-stigma interventions, and how authors conceptualise and measure 'stigma'.

METHODS

This scoping review maps literature on the development and/or evaluation of mass media interventions intended to reduce stigma towards people who use drugs. We systematically searched seven databases for reports about: (i) people who use drugs, (ii) stigma, (iii) mass media. We charted data about intervention (i) subjects and recipients, (ii) format, (iii) authors, (iv) content; and (v) conceptualisation and measurement of stigma. We narratively synthesised findings with qualitative content analyses.

RESULTS

From 14,256 records, we included 49 reports about 35 interventions. 25/35 were from the last five years and 19/35 were from the United States. Intended recipients included the public and/or specified sub-populations, often including healthcare workers. Most interventions were intended to reduce stigma towards people with patterns of drug use perceived to be problematic, as opposed to people who use drugs in general. Interventions ranged from single pieces of media to complex multi-format campaigns. People who use(d) drugs contributed to 22/35 interventions. Professionals working in medical disciplines co-authored 29/35 interventions. Intervention content often had a medical focus, describing dependence as a 'disease' or medical issue, and emphasised the benefits of recovery. Other interventions, however, criticised medical framings. In some interventions drug use and people who use drugs were described in markedly negative terms. 'Stigma' was often under-theorised, and measurement approaches were inconsistent, with 42 instruments used to measure phenomena associated with stigma across 19 quantitative evaluations.

CONCLUSION

We found inconsistencies in approaches to reduce and measure stigma, potentially reflecting different motivations for intervention development. The primary motivation of many interventions was seemingly to promote drug service engagement and recovery.

Barriers to enrolling in voluntary treatment programs in Malaysia: a study of women who use methamphetamine (WWUM)

Women with substance use disorders (SUDs) have been widely reported to face barriers in seeking treatment. We sought to identify barriers that prevented women who use methamphetamine (WWUM) from accessing the decade-old Voluntary Treatment Centers (VTCs) in Malaysia. A total of 153 WWUM who were undergoing rehabilitation for methamphetamine use at a compulsory drug detention center (CDDC) were recruited for this cross-sectional study. Data were collected by canvasing a structured questionnaire through face-to-face meetings. Of the total sample, 131 (86%) were Malays, with a mean age of 32.1 years. The commonly cited treatment barriers were the belief that methamphetamine use was not problematic (42%), not knowing how to seek treatment (38%), feeling embarrassed to seek treatment (33%), the lack of family support (24%), and the long waiting time for enrollment (23%). Logistic analyses indicated that a longer duration of use increased the odds of not acknowledging methamphetamine use as a problem while older participants had lower odds of holding a similar view. A longer duration of use also increased the odds of claiming treatment was not needed but lowered the odds of asserting a lack of confidence in treatment. Furthermore, Malays had higher odds of lacking family support in seeking treatment while being employed lowered the odds of not wanting treatment. Addressing these concerns will hopefully encourage higher participation of WWUM in voluntary treatment programs.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

An Automated Text Messaging Intervention to Reduce Substance Use Self-Stigma (Project RESTART): Protocol for a Feasibility and Acceptability Pilot Study

BACKGROUND

Stigma is a barrier to treatment and harm reduction seeking in people who use drugs. Most stigma reduction interventions offer psychotherapy or psychoeducation in group-based clinical settings, failing to reach people who are not in treatment. SMS text messaging is an effective and acceptable modality for delivering health information to people who use drugs and may be a suitable conduit for providing information and advice to understand and cope with stigma.

OBJECTIVE

This paper presents the protocol for a study that aims to determine the feasibility, acceptability, and preliminary effectiveness of a 4-week automated SMS text message intervention to increase stigma resistance and reduce self-stigma in people who use drugs.

METHODS

We designed a novel automated SMS text message intervention to address the four personal-level constructs of stigma resistance: (1) not believing stigma and catching and challenging stigmatizing thoughts, (2) empowering oneself through learning about substance use and one's recovery, (3) maintaining one's recovery and proving stigma wrong, and (4) developing a meaningful identity and purpose apart from one's substance use. Theory-based messages were developed and pilot-tested in qualitative elicitation interviews with 22 people who use drugs, resulting in a library of 56 messages. In a single-group, within-subjects, community-based pilot trial, we will enroll 30 participants in the Resisting Stigma and Revaluating Your Thoughts (RESTART) intervention. Participants will receive 2 daily SMS text messages for 4 weeks. Implementation feasibility will be assessed through recruitment, enrollment, retention, and message delivery statistics. User feasibility and acceptability will be assessed at follow-up using 23 survey items informed by the Theoretical Framework of Acceptability. Primary effectiveness outcomes are changes in self-stigma (Substance Abuse Self-Stigma Scale) and stigma resistance (Stigma Resistance Scale) from baseline to follow-up measured via a self-administered survey. Secondary outcomes are changes in hope (Adult Dispositional Hope Scale) and self-esteem (Rosenberg Self-Esteem Scale). Feasibility and acceptability will be assessed with descriptive statistics; effectiveness outcomes will be assessed with paired 2-tailed t tests, and group differences will be explored using ANOVA. Overall, 12 participants will also be selected to complete acceptability interviews.

RESULTS

This pilot study was funded by the National Institute on Drug Abuse in April 2023 and received regulatory approval in January 2024 by the University of North Carolina-Chapel Hill Institutional Review Board. Recruitment and enrollment began in March 2024. Follow-up visits are expected to conclude by May 2024. Results will be disseminated in relevant peer-reviewed journals.

CONCLUSIONS

To the best of our knowledge, this is the first study to address substance use stigma via a self-help SMS text messaging program. Results will add to the nascent literature on stigma reduction in people who use drugs. This protocol may interest researchers who are considering text messaging to address psychosocial needs in hard-to-reach populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06281548; https://clinicaltrials.gov/ct2/show/NCT06281548.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59224.

Somebody to Lean on: Understanding Self-Stigma and Willingness to Disclose in the Context of Addiction

Substance use self-stigma is a barrier to treatment and can negatively impact individuals' well-being and treatment engagement. Given the mixed findings in previous research and the limited specific investigation into the concept of self-stigma within the context of opioid misuse, examining factors associated with self-stigma in the context of opioid use disorder (OUD) is warranted. The current study examines the influence of individual-level factors (race, sex, urban/rural status, support group attendance) on self-stigma and willingness to disclose opioid use. Data for this study were from a larger study of OUD-related stigma among adults in Pennsylvania, U.S. The current study included participants who indicated a personal past or current history with OUD were included (n = 84). Exploratory factor analysis and multiple indicators, multiple causes (MIMIC) model were used to explore the associations between demographic factors (i.e., sex, age, race/ethnicity, urban/rural status), attendance at mutual support groups, and self-stigma factors. Results indicated that sex and attendance at mutual support groups significantly predicted levels of self-stigma. Women and individuals with no previous experience attending mutual support groups endorsed lower levels of self-stigma. Additionally, attendance at mutual support groups predicted willingness to self-disclose past and present opioid use. Individuals who reported no history of attending mutual support groups demonstrated less willingness to disclose past and present OUD use compared to participants who were support group attendees. The current research findings enhance the understanding of OUD-related self-stigma by examining its relationship with individual-level factors, disclosure, and attendance to mutual support groups. The results offer insights into the influence of sex and support group attendance on self-stigma and disclosure. These findings have significant clinical implications for developing future interventions and promoting health policy changes.

"A little bit of hope goes a long way": Exploring the role of peer workers in alcohol and other drug rehabilitation services

INTRODUCTION

Peer workers operating within health care settings can offer unique perspectives based on their own lived experience. Within alcohol and other drug (AOD) rehabilitation services, the potential value of peer work is becoming increasingly recognised. This qualitative study aimed to evaluate a newly implemented peer worker program located across three rehabilitation services in Tasmania, Australia.

METHODS

Online interviews were conducted with eight clients, seven peer workers, and five non-peer worker employees with varied experience with peer worker programs. All interviews were audio-recorded and transcribed verbatim.

RESULTS

Guided by an overarching exploratory-descriptive methodological framework, thematic analysis generated three overarching themes: 1) Enhancing and supporting client experiences (what peer workers did in their role to improve client experiences, 2) Changing experiences with AOD rehabilitation (the unique benefits and changes that peer work brings to AOD rehabilitation services) and 3) Finding organizational value (how defining peer work and the feasibility of the peer worker role was challenged by different organizational factors). Overall, peer work was viewed as a positive addition to all rehabilitation services that was able to enhance client experiences through various mechanisms, such as by sharing their own stories, assisting with understanding, and creating safety. Peer work was also able to create change in AOD services, by instilling hope and reducing stigma. However, ongoing challenges with defining the peer worker role in a way that offers organizational recognition and financial security remain.

CONCLUSION

Peer workers offer a unique and valuable perspective when working within rehabilitation services. Through their own lived experience peer workers were able to support clients and assist them in their recovery. These findings highlight the potential benefit of peer work programs within AOD rehabilitation services.

Internalized Shame Among Justice-Involved Women in Substance Use Disorder Treatment: Measurement Invariance and Changes During Treatment

Shame is one of the leading barriers to successful recovery in substance use treatment settings. This secondary analysis study examined measurement invariance of the Internalized Shame Scale (ISS) and explored changes in shame during treatment. Participants (N=105) in the parent study were recruited from a nonprofit residential treatment center for justice-involved women and were randomized to receive mindfulness-based relapse prevention or relapse prevention treatment. A series of confirmatory factor analyses were used to assess measurement invariance in a one-factor measurement model of the ISS. Latent growth curve modeling was used to examine change in shame over time. Our findings support the assumption of measurement invariance across multiple time points and across treatment conditions, supporting comparisons of stigma scores across groups and over time. Although we observed significant reductions in shame from pre- to post-treatment, there were no differences across treatment conditions. Additional research is needed to determine how distinct treatment components relate to reductions in shame among individuals receiving treatment for a substance use disorder.

Reduction in substance use stigma following a peer-recovery specialist behavioral activation intervention

BACKGROUND

Patients' perceptions and experiences of stigma related to substance use and methadone treatment are barriers to successful treatment of opioid use disorder, particularly among low-income and medically underserved populations. Interventions led by peer recovery specialists (PRSs) may shift stigma-related barriers. This study sought to evaluate shifts in substance use and methadone treatment stigma in the context of an evidence-based behavioral intervention adapted for PRS delivery to support methadone treatment outcomes.

METHODS

We recruited patients who had recently started methadone treatment or demonstrated difficulty with adherence from a community-based program (N = 37) for an open-label pilot study of a 12-session behavioral activation intervention led by a PRS interventionist. Participants completed substance use and methadone treatment stigma assessments and the SIP-R, a brief measure of problems related to substance use, at baseline, mid-point (approximately six weeks), and post-treatment (approximately 12 weeks). Generalized estimating equations assessed change in total stigma scores between baseline and post-treatment as well as change in stigma scores associated with change in SIP-R responses.

RESULTS

There was a statistically significant decrease in substance use stigma (b(SE)=-0.0304 (0.0149); p = 0.042) from baseline to post-treatment, but not methadone treatment stigma (b(SE)=-0.00531 (0.0131); p = 0.68). Decreases in both substance use stigma (b(SE)=0.5564 (0.0842); p < 0.001) and methadone treatment stigma (b(SE)=0.3744 (0.1098); p < 0.001) were associated with a decrease in SIP-R scores.

CONCLUSIONS

PRS-led interventions have potential to shift substance use stigma, which may be associated with decrease in problems related to substance use, and therefore merit further testing in the context of randomized controlled trials.

Missing Opportunities in the Screening of Alcohol Use and Problematic Use, and the Provision of Brief Advice and Treatment Information Among Individuals With Alcohol Use Disorder

OBJECTIVES

The aim of this study was to identify sociodemographic and substance-related factors associated with being screened, receiving advice or treatment information from healthcare providers, among individuals who met the criteria for the past 12-month alcohol use disorder (AUD).

METHODS

The 2015-2019 National Survey on Drug Use and Health data were analyzed to identify factors associated with being (1) asked about alcohol used among adults with AUD, who visited a healthcare provider within the past 12 months, and were not receiving AUD treatment (sample 1, n = 13,321); (2) asked about problematic use; (3) advised to reduce consumption; and (4) offered alcohol treatment information, among those in sample 1 who were asked about their use (n = 6,905).

RESULTS

About half (52.9%) in sample 1 were asked about their alcohol use. Among them, 21.6% were asked about problematic use, 17.7% were advised to reduce alcohol consumption, and 7.6% were offered information. The odds of being asked about alcohol use among male participants were 0.72 times the odds of female participants; however once asked, male participants showed greater odds of being asked about problematic use (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI] = 1.29-1.82), advised to reduce consumption (aOR = 1.64, 95% CI = 1.24-2.16), and offered treatment information (aOR = 1.77, 95% CI = 1.34-2.35). As compared with non-Hispanic White participants, other racial/ethnic groups were less likely to be asked about alcohol use; however, once asked, no differences were observed for other outcomes.

CONCLUSIONS

Significant gaps in the screening and provision of advice or treatment information were identified, particularly for racial/ethnic and sex subgroups. Reducing barriers for effective screening could help address AUD-related disparities.

Patient perceptions of and experiences with stigma using telehealth for opioid use disorder treatment: a qualitative analysis

BACKGROUND

Patients with opioid use disorder (OUD) experience various forms of stigma at the individual, public, and structural levels that can affect how they access and engage with healthcare, particularly with medications for OUD treatment. Telehealth is a relatively new form of care delivery for OUD treatment. As reducing stigma surrounding OUD treatment is critical to address ongoing gaps in care, the aim of this study was to explore how telehealth impacts patient experiences of stigma.

METHODS

In this qualitative study, we interviewed patients with OUD at a single urban academic medical center consisting of multiple primary care and addiction clinics in Oregon, USA. Participants were eligible if they had (1) at least one virtual visit for OUD between March 2020 and December 2021, and (2) a prescription for buprenorphine not exclusively used for chronic pain. We conducted phone interviews between October and December 2022, then recorded, transcribed, dual-coded, and analyzed using reflexive thematic analysis.

RESULTS

The mean age of participants (n = 30) was 40.5 years (range 20-63); 14 were women, 15 were men, and two were transgender, non-binary, or gender-diverse. Participants were 77% white, and 33% had experienced homelessness in the prior six months. We identified four themes regarding how telehealth for OUD treatment shaped patient perceptions of and experiences with stigma at the individual (1), public (2-3), and structural levels (4): (1) Telehealth offers wanted space and improved control over treatment setting; (2) Public stigma and privacy concerns can impact both telehealth and in-person encounters, depending on clinical and personal circumstances; (3) The social distance of telehealth could mitigate or exacerbate perceptions of clinician stigma, depending on both patient and clinician expectations; (4) The increased flexibility of telehealth translated to perceptions of increased clinician trust and respect.

CONCLUSIONS

The forms of stigma experienced by individuals with OUD are complex and multifaceted, as are the ways in which those experiences interact with telehealth-based care. The mixed results of this study support policies allowing for a more individualized, patient-centered approach to care delivery that allows patients a choice over how they receive OUD treatment services.

Perceptions on Treatment Utilization and Risk of Overdose Among Opioid Users in Kolkata: A Qualitative Study

Objective

This study was performed to explore the perceptions of treatment utilization patterns and the risk of overdose of both opioid users and their peer educators in Kolkata, India.

Methods

This study used a qualitative approach for data collection between September and December 2023. In-depth interviews (IDIs) of 20 opioid users from two authorized opioid substitution therapy (OST) centers (10 registered clients) and their respective field practice areas (10 unregistered clients) in Kolkata were conducted. Key informant interviews (KIIs) of six peer educators were also conducted. Semi-structured interviews were conducted; audio was recorded, transcribed, and translated for coding and analysis. An inductive thematic analysis was performed.

Results

Six broad themes (individual knowledge, logistics, legal/administrative, treatment effectiveness, self-confidence of treatment, and poor knowledge about the antidote of opioid poisoning, i.e., naloxone) emerged from the data analysis of IDIs. Four broad themes (high-risk behavior, raising awareness, the benefits of OST, and poor knowledge about naloxone) emerged from the data analysis of KIIs. Both opioid users and their peer educators were aware of the dangers of opioid overdose. However, they lacked sufficient knowledge in recognizing and offering immediate assistance in instances of opioid overdose, including the administration of naloxone.

Conclusion

The findings recognize the necessity of drawing and retaining opioid users in an efficient healthcare facility, such as OST centers, and providing them adequate training to identify and provide immediate assistance in cases of overdose, including naloxone administration. Our findings will assist policymakers in designing programs to prevent and treat opioid overdoses.

Epidemiology of alcohol use disorder in the general population of Togo and Benin: the ALCOTRANS study

INTRODUCTION

Access to data concerning mental health, particularly alcohol use disorders (AUD), in sub-Saharan Africa is very limited. This study aimed to estimate AUD prevalence and identify the associated factors in Togo and Benin.

METHODS

A cross-sectional study was conducted between April and May 2022, targeting individuals aged 18 years and above in the Yoto commune of Togo and the Lalo commune of Benin. Subjects were recruited using a multi-stage random sampling technique. AUD diagnoses were made using the MINI adapted to DSM-5 criteria. Our study collected sociodemographic information, data on psychiatric comorbidities, stigmatization, and assessed cravings, using a series of scales. The association between AUD and various factors was analyzed using multivariable logistic regression.

RESULTS

In Togo, 55 of the 445 people investigated had AUD (12.4%; [95% CI: 9.5-15.7%]). Among them, 39 (70.9%) had severe AUD and the main associated comorbidities were suicidal risk (36.4%), and major depressive disorder (16.4%). Associated factors with AUD were male gender (aOR: 11.3; [95% CI: 4.8-26.7]), a higher Hamilton Depression Rating Scale (HDRS) score (aOR: 1.2; [95% CI: 1.1-1.3]) and a lower Stigma score measured by the Explanatory Model Interview Catalogue (EMIC) (aOR: 0.9; [95% CI: 0.8-0.9). The stigma scores reflect perceived societal stigma towards individuals with AUD. In Benin, 38 of the 435 people investigated had AUD (8.7%; [95% CI: 6.4-11.7]), and the main associated comorbidities were suicidal risk (18.4%), tobacco use disorder (13.2%) and major depressive episode (16.4%). Associated factors with AUD were male gender (aOR: 6.4; [95% CI: 2.4-17.0]), major depressive disorder (aOR: 21.0; [95% CI: 1.5-289.8]), suicidal risk (aOR: 3.7; [95% CI: 1.2-11.3]), a lower Frontal Assessment Battery (FAB) score (aOR:0.8; [95% CI: 0.8-0.9]) and a lower perceived stigma score (by EMIC )(aOR: 0.9; [95% CI: 0.8-0.9]).

CONCLUSION

In these communes of Togo and Benin, AUD prevalence is notably high. A deeper understanding of the disease and its local determinants, paired with effective prevention campaigns, could mitigate its impact on both countries.

A Systematic Review of the Effect of Stigmatization on Psychiatric Illness Outcomes

A significant proportion of individuals with psychiatric disorders face dual challenges such as managing the symptoms and disabilities of their conditions and enduring stigma arising from misconceptions about mental illness. This stigma denies them quality-of-life opportunities, such as access to satisfactory healthcare services, better employment, safer housing, and social affiliations. This systematic review aims to evaluate the effect of stigmatization on psychiatric illness outcomes, particularly its influence on treatment adherence, treatment-seeking behavior, and care outcomes. We conducted a systematic review of 39 studies published between 2010 and 2024, focusing on the effects of stigmatization on psychiatric illness outcomes. The review utilized robust methodology following Cochrane guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies from 2010 to 2024 obtained from databases such as PubMed, Embase, Google Scholar, Web of Science, and SCOPUS. The quality of the included studies was assessed using the Appraisal Tool for Cross-Sectional Studies, with most studies rated as moderate to high quality. The findings indicate that stigma in psychiatric illness is closely associated with several factors, including illness duration (mean effect size = 0.42, p < 0.05), frequency of clinic visits (mean reduction = 2.3 visits/year), and diagnosis of psychotic disorders (OR = 1.78, 95% CI: 1.20-2.65). Stigma manifests through misinformation, prejudice, and discrimination, leading to significant barriers to accessing and adhering to psychiatric treatment, thereby worsening health outcomes. It leads to delays in accessing healthcare, poor adherence to medication and follow-up, and negative psychiatric health outcomes, including disempowerment, reduced self-efficacy, increased psychiatric symptoms, and decreased quality of life. Also, stigma extends to caregivers and healthcare professionals, complicating care delivery. This review highlights the need for effective interventions and strategies to address stigma, emphasizing the importance of educational interventions to mitigate the adverse effects of public stigma. Understanding the multifaceted nature of stigma is crucial for developing targeted approaches to improve psychiatric care outcomes and ensure better mental health services for individuals with mental illnesses.

Characterizing Multisystem Barriers to Women's Residential SUD Treatment: A Multisite Qualitative Analysis in Los Angeles

Residential substance use disorder (SUD) treatment programs are challenged by the differing values of the problem-solving court (PSC) and child welfare (CW) systems, along with communication barriers between staff. This study aimed to understand, from the viewpoints of SUD treatment providers, how divergent values and communication barriers adversely affect women's residential SUD treatment. We conducted qualitative semistructured interviews with 18 SUD treatment clinicians and six directors from four women's residential SUD treatment programs. Using a thematic analysis framework, we identified salient themes across specified codes. Analysis revealed six main themes, suggesting differing values and communication barriers across the SUD, PSC, and CW systems adversely affect the provision of SUD treatment. For differing values, three main themes emerged: (a) unaddressed trauma and fear of mental health treatment seeking; (b) perceptions of mothers with a SUD; and (c) the Adoption and Safe Families Act (ASFA) timeline as a barrier to SUD treatment provision. For communication barriers, three themes emerged: (a) inadequate communication and responsiveness with PSC and CW systems adversely affect treatment coordination, induce patient stress, and treatment disengagement; (b) lack of PSC and CW communication regarding child visitation planning adversely affects treatment motivation and retention; and (c) competing ASFA, PSC, and CW priorities and inadequate cross-system communication adversely affect treatment planning. Treatment providers face significant barriers in providing effective treatment to women simultaneously involved in the CW and PSC systems. Aligning values and addressing communication barriers, changes in policy, and enhanced cross-system training are crucial. Additionally, it is essential to reevaluate the ASFA timeline to align with the long-term treatment needs of mothers with a SUD. Further research should explore the viewpoints of patients, CW, and PSC staff to gain deeper insights into these SUD treatment barriers.

Effectiveness of proactive video therapy for problematic alcohol use on treatment initiation, compliance, and alcohol intake: a randomised controlled trial in Denmark

BACKGROUND

Few people with problematic alcohol use reach treatment and dropout is frequent. Therapy for problematic alcohol use delivered via video conference (e-alcohol therapy) might overcome treatment barriers. In this randomised study, we tested whether proactive e-alcohol therapy outperformed face-to-face alcohol therapy (standard care) regarding treatment initiation, compliance, and weekly alcohol intake at 3-month and 12-month follow-up.

METHODS

In this two-arm randomised controlled trial, we recruited individuals who had problematic alcohol use, defined as a score of 8 or more on the Alcohol Use Disorders Identification Test; were 18 years or older; and had access to a personal computer, smartphone, or tablet with internet access in Denmark through online advertisements. Participants were assigned to receive alcohol therapy delivered either face-to-face or via video conference. The number, frequency, and duration of therapy sessions were individualised in both groups. Data analysis was conducted using masked data. Primary analyses were based on an intention-to-treat sample. The study is registered with ClinicalTrials.gov (NCT03116282).

FINDINGS

Between Jan 22, 2018, and June 29, 2020, 816 individuals signed up for the trial and 502 (63%) were assessed for eligibility. We randomly assigned 379 to proactive e-alcohol therapy (n=187) or standard care (n=192), of which, 170 (48%) participants were female and 186 (52%) were male. In the intervention group, more participants initiated treatment (155 [88%] of 177 vs 96 [54%] of 179; odds ratio [OR] 6·3; 95% CI 2·8 to 13·8; p<0·0001 at 3 months; 151 [85%] of 177 vs 115 [64%] of 179; OR 3·2; 95% CI 1·6 to 6·2; p=0·0007 at 12 months) and complied with treatment (130 [73%] of 177 vs 74 [41%] of 179; OR 4·0; 95% CI 2·2 to 7·2; p<0·0001 at 3 months; 140 [79%] of 177 vs 95 [53%] of 179; OR 3·4; 95% CI 1·8 to 6·3; p=0·0002 at 12 months). Weekly alcohol intake was significantly lower in the intervention group only after 3 months (13·0 standard drinks per week vs 21·3 standard drinks per week; adjusted difference -6·7; 95% CI -12·3 to -1·0; p=0·019).

INTERPRETATION

Proactive e-alcohol therapy was associated with increased treatment initiation and compliance and is promising as an easily accessible and effective alcohol treatment for individuals with problematic alcohol use.

FUNDING

TrygFonden.

The Causes and Consequences of Stigma among Individuals Involved in the Criminal Legal System: A Systematic Review

The purpose of this study was to systematically review the types of stigmatized attributes that have been assessed and the causes and consequences of stigma for individuals involved in the criminal legal system. PubMed, GoogleScholar, and PsycInfo databases were searched to identify studies for inclusion through March 2021. Eligible studies were peer-reviewed, quantitative, and assessed stigma from the perspective of the person involved in the criminal legal system. 59 studies were included (total n=21,738), assessing stigma associated with criminal involvement, HIV, substance use, race/ethnicity, help-seeking, and others. Experiencing criminal involvement stigma was linked to poor well-being, but less so for racial/ethnic minorities. Experiencing racial/ethnic stigma was associated with recidivism risk, and substance use stigma was associated with substance use risk. Several stigmas intersected to impact treatment engagement and well-being. In conclusion, individuals involved in the criminal legal system experience many stigmatized statuses that impact their well-being, treatment adherence, community integration, and criminal behavior. Stigma must be addressed among individuals involved in the criminal legal system and the systems they interact with to reduce health inequity and recidivism risk.

"It's My Secret": Shame as a Barrier to Care in Individuals With Opioid Use Disorder

BACKGROUND

Substance use disorder (SUD) is a chronic illness impacting more than 59 million Americans last year. Opioid use disorder (OUD) is a subset of SUD. The literature supports that healthcare providers frequently stigmatize patients with OUD. Individuals with OUD often feel shame associated with their disorder. Shame has been associated with maladaptive and avoidant behaviors.

AIM

The aim of this qualitative descriptive study was to examine and describe the experiences of shame and health-seeking behaviors in individuals with OUD.

METHODS

A qualitative exploratory design using focus groups with individuals in treatment for OUD was used to identify the issue of shame and its relationship to health-seeking behaviors.

RESULTS

A systematic content analysis of discussions with 11 participants in four focus groups revealed four major themes and associated subthemes: Avoidance of Preventive Care (belief providers are judgmental); the Hidden Disorder (keeping secrets); Constraints of Shame (justification for the continuation of drug usage); and Trust in MOUD (Medication for Opioid Use Disorder) Providers. The feeling of shame leads to a reluctance to engage in health-promoting actions, such as scheduling appointments with primary care providers and dentists.

CONCLUSION

Healthcare practitioners must prioritize providing a safe, nonstigmatizing environment for patients with SUD/OUD. This includes establishing trust and rapport, providing education, collaboration with psychiatric mental health specialists and other healthcare providers, and the offering support and resources to help patients manage their condition to achieve optimal health outcomes.

Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies

BACKGROUND

The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use.

OBJECTIVE

We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community.

METHODS

We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences.

RESULTS

Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by -6.79 days of use in the previous month (95% CI -9.59 to -4.00; P<.001).

CONCLUSIONS

Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults.

TRIAL REGISTRATION

PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959.