Unemployment and Substance Use: An Updated Review of Studies from North America and Europe

Drug addiction and impact of urbanization: a systematic review

PURPOSE OF REVIEW

Using the ecological public health framework, this study aims to systematically review the risk of illicit drug use and its associated negative health outcomes relating to urbanization.

RECENT FINDINGS

Previous studies have indicated that urbanization associated with increased population density drives segregation of vulnerable communities of low socioeconomic status (SES). Marginalized individuals in segregated communities have increased risk of poor mental health and illicit drug use.

SUMMARY

The results indicated that urban-specific environmental risk factors, individual characteristics and level of social support all influenced risk of drug use, substance use disorder (SUD), overdose, and drug-use associated death. Urban environmental risk factors of economic disparity, marginalization and barriers in accessing healthcare and negative individual characteristics of low education, low income and comorbid diagnosis of mental illness significantly increased risk of drug use. In contrast, better social support reduced the risk of drug use.

Illegal drug use amongst male UK military personnel who sustained physical combat injuries: The ADVANCE cohort study

Illegal drug use may be a consequence of sustaining a serious physical combat injury, though no known research has investigated this in a UK setting. This analysis utilises the baseline data from a longitudinal cohort (ADVANCE), to assess whether 577 UK military personnel who sustained serious physical combat injuries reported more illegal drug use compared to 565 frequency-matched personnel without such injuries. Most personnel reported no illegal drug use in the past year (88.7%). Cocaine was the most common drug reported in the past year, followed by cannabis. Injured personnel had greater odds of reporting illegal drug use in the past year compared to the comparison group (injured group: 16.3%, comparison group: 5.4%; Odds Ratio (OR) 3.09 (95% CI 2.03, 5.31)), however, no differences were observed amongst veterans in each group (OR 0.67 (95% CI 0.40, 1.27)). Higher prevalence of illegal drug use was observed amongst those of white ethnic background, lower rank, those who were single, younger, veterans, and those who reported a probable mental illness, suicidal ideation or heavy alcohol use/tobacco use. Veterans who left service at a younger age and with a shorter length of service were also identified as having higher prevalence of illegal drug use. UK Armed Forces personnel who sustained serious physical combat injuries in Afghanistan report more illegal drug use in the past year compared to demographically similar personnel without serious physical injury. Greater prevalence of illegal drug use was evident in those that left service, with >20 % of veterans reporting illegal drug use in the past year.

Expanding contexts of medicalization: The role of policy legacies, race, and class in the prevalence of treatment courts

The current study seeks to examine the association between political and sociodemographic contexts and medicalization by analyzing the prevalence of treatment courts. Using a compiled dataset of 3,132 U.S. counties across all 50 states in 2020, I examine the effect of policy legacies and racial and socioeconomic makeup on the prevalence of treatment courts, which are medicalized alternatives to traditional criminal justice involvement (e.g., incarceration). Regardless of rates of mental distress, substance use, crime rates, population size, and other relevant measures, I find that counties with higher proportions of Black and college educated residents are more likely to have mental health treatment courts. I also find that counties in conservative states and in the South have fewer treatment courts, and that counties with punitive state criminal justice policies (e.g., the death penalty) report fewer treatment courts. I discuss the implications of these findings for our understanding of the social and political contexts that facilitate medicalization, as well as for the spread of treatment courts.

Prevalence and determinants of cigarette-cannabis co-use among US cancer survivors

PURPOSE

We estimated the prevalence of cigarette-cannabis co-use and investigated the individual-level factors associated with cigarette-cannabis co-use among adult (aged ≥ 18) cancer survivors.

METHODS

We used population-based data from the 2022 Behavioral Risk Factor Surveillance System. The sample included 9,323 (weighted 2,711,650) adult cancer survivors residing in 16 US states and two US territories. The outcome was cigarette-cannabis co-use, examined using multinomial multivariable logistic regression models.

RESULTS

Overall, 81.83% self-reported as white, 58.97% women, and 57.69% aged ≥ 65. About 12.00% reported current cigarette use, 10.36% past 30-day cannabis use, and 3.28% cigarette-cannabis co-use. The odds of cigarette-cannabis co-use were greater for younger survivors (18-49 years), those with high school or less education, not in the workforce, and divorced, separated, widowed, or never married individuals. Further, survivors with ≥ 3 comorbidities (vs. no-comorbidity), ≥ 14 days of poor mental health days (vs. none), and ≥ 14 days of poor physical health (vs. none) in the past month also had increased odds of cigarette-cannabis co-use.

CONCLUSIONS

The study findings suggest that certain subgroups of cancer survivors are more likely to engage in cigarette-cannabis co-use, and these patterns are associated with individual-level factors.

IMPLICATIONS FOR CANCER SURVIVORS

New strategies and tailored interventions targeting cigarette-cannabis co-use among cancer survivors are critically needed to improve the overall well-being of cancer survivors. Future research should explore additional factors to fully understand cigarette-cannabis co-use in cancer survivors.

The epidemiology of substance use disorders in Saudi Arabia: findings from the Saudi national mental health survey

BACKGROUND

Substance use disorders (SUDs), encompassing alcohol (AUDs) and drug use disorders (DUDs), are significant global public health concerns. While SUDs are well-documented worldwide, data on their prevalence and impact in Saudi Arabia remain scarce. This study investigates the epidemiology and burden of SUDs in Saudi Arabia using data from the Saudi National Mental Health Survey (SNMHS).

METHODS

The SNMHS is a nationally representative cross-sectional epidemiological household survey, consisting of a sample of 4,004 participants aged 15-65. The survey employed a stratified multistage clustered sampling design and used the WHO CIDI 3.0 to determine diagnoses. Descriptive statistics and multivariate binary logistic regression were used to analyze the data.

RESULTS

The lifetime, 12-month, and 30-day prevalence of any SUD were 4.03%, 1.88%, and 0.78% (p < 0.05), respectively. DUDs were more prevalent than AUDs overall. SUDs were significantly associated with younger age, lower education, low income, exposure to traumatic events, family burden, and childhood adversities. High psychiatric comorbidity and role impairment were observed. Treatment seeking was moderate, with only 44.9% of those with lifetime SUDs seeking any form of treatment.

CONCLUSIONS

SUDs in Saudi Arabia are more prevalent than previously thought, associated with significant psychiatric comorbidities and role impairment. Despite this, treatment seeking remains inadequate. These findings underscore the need for targeted prevention and intervention programs tailored to the demographic and cultural context of Saudi Arabia.

The Impact of COVID-19 on Substance Use and Related Consequences Among Patients in Office-based Opioid Use Disorder Treatment

OBJECTIVES

The COVID-19 pandemic led to increased substance-related morbidity and mortality and transformed care for opioid use disorder (OUD). We assessed the perceived impacts of the pandemic on substance use and related consequences among patients in office-based addiction treatment (OBAT).

METHODS

We recruited patients with OUD on buprenorphine from July 2021 to July 2022, with data collection at baseline and 6 months. Exposures of interest were the following 6 domains potentially impacted by COVID-19: personal or family infection, difficulty accessing healthcare/medication, economic stressors, worsening physical or mental health, social isolation, and conflicts/disruptions in the home. Outcomes were past 30-day alcohol and other substance use, increased use, and substance-related consequences at baseline and 6 months. Generalized estimating equations Poisson regression models quantified associations between increasing impact domain scores and relative risks of each outcome.

RESULTS

All participants (N = 150) reported at least one domain negatively impacted by COVID-19 at both time points. Higher "worsening physical or mental health" domain scores were associated with increased relative risk of recent alcohol or drug use (adjusted risk ratio [aRR] 1.04, 95% confidence interval [CI]: 1.01-1.07). Relative risks of experiencing substance-related consequences increased with higher scores in the domains of economic stressors (aRR 1.07, 95% CI: 1.02-1.13), difficulty accessing healthcare/medication (aRR 1.11, 95% CI: 1.04-1.19), and worsening physical or mental health (aRR 1.08, 95% CI: 1.04-1.12).

CONCLUSIONS

Among patients with OUD, stressors from COVID-19 were common. Three life domains impacted by COVID-19 appeared to be associated with consequential substance use, highlighting opportunities to address barriers to healthcare access and economic stressors.

Association Between Unemployment and Mental Disorders: A Narrative Update of the Literature

The relationship between unemployment and mental disorders has been a significant subject of study since at least the Industrial Revolution. However, most data show associations of unemployment and isolated mental disorders, and this study field has been neglected in the last years. Therefore, this narrative review aims to provide an updated overview of the association between unemployment and mental health in general as well as the most prevalent mental disorders. A literature search was conducted using PubMed with the initial search terms "unemployment" and "mental health". The identified disorders were then used as search terms for a more in-depth search. Two raters screened abstracts and identified the literature containing relevant information. As a main result, it could be demonstrated that regardless of age and sex, there is still a broad association between unemployment and mental well-being in general (e.g., quality of life measure for example by the General Health Questionnaire), suicide attempts, suicide rates, as well as specific psychiatric disorders (substance use disorder, schizophrenia, depression, bipolar disorders, compulsive/obsessive disorders, eating disorders, specific personality disorders, intelligence disorders/impairment, and ADHD). The most significant association was found for affective disorders (depression) and substance use disorders. The association in general was particularly evident for long-term unemployment and mental disorders. Returning to work reduced the prevalence rates of mental disorders significantly. The literature review confirms the results of much older and disease centered studies that unemployment and mental disorders are associated with each other. The main conclusion is that early medical detection and intervention among the mentally ill are as crucial as labor market policy interventions to prevent, avoid, and reduce unemployment.

Unemployment and mental health: a global study of unemployment's influence on diverse mental disorders

Introduction

Globally, one in five individuals faces unemployment, which substantially increases their risk of developing mental disorders. Understanding the relationship between unemployment and specific mental health outcomes is crucial for formulating effective policy interventions.

Methods

This study examines the relationship between unemployment and mental disorders across 201 countries from 1970 to 2020. Using a fixed-effects model, we analyze the impact of unemployment on various mental health outcomes, including anxiety, depression, bipolar disorder, drug use, and eating disorders, with a focus on demographic variations.

Results

The analysis reveals a significant positive association between unemployment and mental disorders, particularly anxiety, depression, and bipolar disorder. Moreover, distinct patterns emerge, linking unemployment to higher rates of drug use and eating disorders in specific demographics.

Discussion

These findings underscore the critical interplay between socio-economic factors and mental health, highlighting the need for proactive strategies to address the dual burden of unemployment and mental health disorders. Targeted interventions, such as employment support programs and accessible mental health services, are essential to improve global mental health outcomes. These initiatives can also alleviate the economic burden of unemployment by boosting workforce participation and productivity. Long-term economic gains may offset the increased healthcare expenditures associated with mental health support.

Harm reduction-focused behavioral activation for people who inject drugs: Mixed methods outcomes from a pilot open trial

INTRODUCTION

People who inject drugs (PWID) experience high rates of mental health problems and drug-related harms. Harm reduction-focused interventions aim to reduce harms associated with drug use and are an important approach for engaging people who are not seeking traditional abstinence-focused treatment. Yet, few studies to date have examined the effectiveness of harm reduction psychosocial treatment for drug use. We evaluated the outcomes of a harm reduction-focused behavioral activation (BA) intervention from pretreatment to a 1-month follow-up.

METHODS

A total of N = 23 PWID (65.2 % White; 52.2 % women; mean age 35.4 ± 7.8 years) were recruited from syringe services programs and n = 19 received the intervention via teletherapy. Assessment of study outcome measures occurred at pre- and posttreatment and a one-month follow-up.

RESULTS

Results reflected post-intervention increases in behavioral activation and readiness to change drug use, as well as decreases in substance use, depression, and HIV risk behaviors. There were mixed outcomes on substance-related problems with increases at follow-up, possibly reflecting increased problem recognition.

CONCLUSIONS

These results suggest initial promise for the harm reduction-focused treatment. Additional research with randomized designs and larger sample sizes is needed, and more intensive treatment may be required to support sustained treatment gains in this population.

Recovery Residences Are an Innovative Site for HIV Prevention Interventions Targeting People Who Inject Drugs: Preliminary Data From Project HOMES

Of 1.2 million Americans who would benefit from pre-exposure prophylaxis (PrEP), only 36% were prescribed PrEP in 2023. Project HOMES is an ongoing study that evaluates recovery residences for individuals in medication-assisted recovery from opioid use disorder across five Texas cities. Behavioral and psychosocial survey data and biomarkers were collected with a focus on the history of HIV testing, PrEP awareness, and willingness to engage in preventive treatments from a subsample of participants. Preliminary results demonstrated varying levels of HIV testing (83%), PrEP awareness (51%), and willingness to use PrEP (44%) among residents. Willingness to use PrEP was further differentiated by the method of administration, including the preference for pills (40%) and injections (40%). The findings underscore the critical role that recovery residences could play in PrEP access and addressing health care disparities among people with a history of injecting drugs.

Substance Use Among People Seeking Health Care Services in Primary Health Care Settings in Coastal Karnataka

Background

Patients with substance use disorders are common in general medical practice and are a major risk factor for several non-communicable diseases. Appropriate screening is a vital step for providing brief interventions which can provide a good opportunity to tackle this crisis and in achieving target 3.5 of the sustainable development goal which includes strengthening the prevention and treatment of substance abuse.

Objectives

To study the magnitude of substance use and factors associated with it among people seeking health care services at primary care settings.

Methods

The cross-sectional study recruited people seeking services at primary care settings to screen for substance users (SU) and determine the associated factors. The data was collected using a pretested semi-structured questionnaire including socio-demographic characteristics, health status and the Alcohol, Smoking and Substance Involvement Screening Test tool.

Results

The study showed that 43.4% of the participants were SU. The current use of smokeless tobacco was higher compared to tobacco smoking (21.3% and 4.7%). The multivariate logistic regression showed that advancing age (AOR: 2.61 and 95% CI of 1.01-6.79), male gender (AOR: 705 and 95% CI of 4.25-11.70), primary and middle school (AOR: 3.24 and 95% CI of 1.52-6.92) literacy status, unemployed (AOR: 0.49 and 95% CI of 0.25-0.95), religion and other backward caste (AOR: 2.42 and 95% CI of 1.37-4.30) were significant correlates of SU.

Conclusion

Substance use was reported by two-fifths of the participants seeking services at primary care centres in our study and stresses the need for incorporating brief interventions to prevent higher degrees of dependence and its complications.

Racial and gender differences in relapse potential and treatment acceptance among rural residents in a substance use disorder treatment program

PURPOSE

To examine racial and gender differences in treatment acceptance and relapse potential among rural residents admitted to a substance use disorder (SUD) treatment program.

METHODS

A cross-sectional study using data collected from a sample of 1850 rural residents admitted to a South Carolina state-run SUD treatment center between the years of 2018 and 2020. Chi-square and t-tests were used to compare treatment acceptance and relapse potential by race and gender. Multivariate logistic regression analyses was conducted to further examine the relationship of race and gender with treatment acceptance and relapse potential after adjusting for potential confounding variables.

FINDINGS

Approximately 50% of participants were classified as being accepting of their treatment and committed to changing their substance use, and there were no racial or gender differences in the bivariate and multivariate analyses. Approximately 25% of participants were classified as having low/no potential risk for relapsing, and there were no racial or gender differences in the bivariate analysis. However, the adjusted odds ratio of relapsing risk were lower among White compared to Black adults [AOR = 0.49 with 95% CI (0.31-0.77)].

CONCLUSION

This study suggests there are no gender or racial differences in treatment acceptance for SUD but that Black adults are at greater risk of relapsing relative to White adults. Additional research is needed to identify factors that increase Black adults' risk for relapse to inform interventions that can improve SUD treatment outcomes in this population.

[Socio-medical assessment: an inventory of the Medical Service of the Federal Employment Agency]

INTRODUCTION

The Medical Service of the Federal Employment Agency is responsible for socio-medical assessments of clients whose ability to work in the labor market is in question. Data about the Medical Service, its structure, and its performance were previously only available within the Federal Employment Agency.

METHODS

In October 2023, data from the Medical Service containing information on the employee structure, clients, and orders were extracted from three data systems, processed, and analyzed.

RESULTS

The number of full-time equivalents (FTEs) in the Medical Service decreased significantly from 2016 (n = 859.1 FTEs) to 2021 (n = 799.0 FTEs). This holds true for the professional groups of physicians, specialist assistants, medical assistants, and externally contracted physicians. The number of female employee FTEs rose significantly during this period from 85.6% (2016) to 87.0% (2021). The part-time ratio also increased significantly from 41.4% (2016) to 50.6% (2021). The number of assignments to the Medical Service was stable in 2017-2019 at around 630,000 but showed a reduction in 2020 (n = 518,538) and 2021 (n = 545,289); in particular, the number of assessments with client contact decreased significantly from 2019 (n = 166,980) to 2020 (n = 52,484). Most of the assignments came from the field of job placement (n = 349,346).

DISCUSSION

The size of the Medical Service was in line with the total number of orders, which can certainly be seen as COVID-19-related in 2020 and 2021 and is likely due to the overall shortage of skilled personnel. The proportion of women and part-time employees increased significantly, with a nationwide part-time trend emerging not only among women. In order to enable all clients who may be unable to perform in the labor market to receive a quick assessment, it is necessary that the number of employees in the Medical Service does not decrease in the future.

Analyzing the geographic influence of financial inclusion on illicit drug use in Nigeria

Nigeria grapples with a formidable public health concern, as approximately 14 million individuals partake in illicit drug use (IDU). This predicament significantly impacts psychiatric disorders, suicides, disability, and mortality rates. Despite previous investigations into predictors and remedies, the role of financial inclusion (FI) remains inadequately explored. Leveraging existing literature on FI and population health, this study asserts that bolstering FI could be instrumental in mitigating IDU prevalence in Nigeria. We employ spatial analysis to scrutinize the influence of FI and other social factors on IDU, revealing a 14.4 % national prevalence with spatial variations ranging from 7 % in Jigawa state to 33 % in Lagos state. Significant IDU hotspots were identified in the southwest states, while cold spots were observed in the Federal Capital Territory and Nassarawa. Multivariate spatial analysis indicates that FI, income, unemployment, and the proportion of the young population are pivotal predictors of IDU nationwide, explaining approximately 67 % of the spatial variance. Given these findings, the study advocates heightened levels of FI and underscores the need for intensified government initiatives to prevent and address illicit drug use.

Climacteric status at age 46 is associated with poorer work ability, lower 2-year participation in working life, and a higher 7-year disability retirement rate: a Northern Finland Birth Cohort 1966 study

OBJECTIVE

To study the association between an advanced climacteric status at 46 years of age and current perceived work ability, the consequent 2-year accumulation of disability and unemployment days, and the 7-year incidence of disability pensions.

METHODS

Study participants (n = 2,661) were recruited from the Northern Finland Birth Cohort 1966 study's 46-year follow-up in 2012. The participants' perceived work ability was investigated using the Work Ability Score (0-7 = poor vs 8-10 = good), along with potential covariates. Data concerning their consequent disability days, unemployment days, and disability pensions were collected from national registers. The association between their climacteric status at age 46 years, work ability, and working life participation was assessed using regression models.

RESULTS

The climacteric women were more often smokers and more often had a lower level of education. The odds ratio for poor perceived work ability was 1.41 (95% CI, 1.06-1.87), and the incidence rate ratios for disability and unemployment days during the 2-year follow-up were 1.09 (95% CI, 1.07-1.11) and 1.16 (95% CI, 1.14-1.18), respectively, for the climacteric women compared with the preclimacteric women in models adjusted for smoking and education. The 7-year hazard ratio for disability pensions was 1.72 (95% CI, 1.02-2.91) for the climacteric women.

CONCLUSIONS

An earlier menopausal transition is associated with poorer perceived work ability, and it predicts lower recorded work participation and a higher disability pension rate in subsequent years.

Not Two Sides of the Same Coin: A Qualitative Comparative Analysis of Post-Treatment Abstinence and Relapse

Purpose

Substance use disorder (SUD) can be a chronic relapsing condition with poor treatment outcomes. Studies exploring factors associated with abstinence or relapse after treatment are often quantitative in nature, applying linear statistical approaches, while abstinence and relapse result from non-linear, complex, dynamic and synergistic processes. This study aims to explore these underlying dynamics using qualitative comparative analysis (QCA) as a mixed methods approach to further our understanding of factors contributing to post-treatment abstinence and relapse.

Patients and Methods

In a prospective study, we gathered both qualitative and quantitative data pertaining to post-treatment substance use and the factors linked to substance use outcomes. These factors encompassed psychiatric comorbidity, intellectual disability, social disintegration, post-treatment support, and engagement in activities among patients who had undergone inpatient treatment for severe SUD (n = 58). QCA, a set-theoretic approach that considers the complex interplay of multiple conditions, was applied to discern which factors were necessary or sufficient for the occurrence of either abstinence or relapse.

Results

We found two solutions predicting abstinence, and five for relapse. Post-treatment conditions (support and engagement in activities) were important for retaining abstinence. For relapse, individual baseline characteristics (intellectual disability, social disintegration, psychiatric comorbidity) combined with (post-)treatment factors (post-treatment support, activities) were important.

Conclusion

Although abstinence and relapse represent opposing outcomes, they each exhibit distinct dynamics. To gain a comprehensive understanding of these dynamics, it is advisable to examine them as separate outcomes. For clinical practice, it can be worthwhile to recognize that fostering the conditions conducive to abstinence may differ from preventing the factors that trigger relapse.

Sex difference in the effect of environmental enrichment on food restriction-induced persistence of cocaine conditioned place preference and mechanistic underpinnings

Psychosocial and environmental factors, including loss of natural reward, contribute to the risk of drug abuse. Reward loss has been modeled in animals by removal from social or sexual contact, transfer from enriched to impoverished housing, or restriction of food. We previously showed that food restriction increases the unconditioned rewarding effects of abused drugs and the conditioned incentive effects of drug-paired environments. Mechanistic studies provided evidence of decreased basal dopamine (DA) transmission, adaptive upregulation of signaling downstream of D1 DA receptor stimulation, synaptic upscaling and incorporation of calcium-permeable AMPA receptors (CP-AMPARs) in medium spiny neurons (MSNs) of nucleus accumbens (NAc). These findings align with the still evolving 'reward deficiency' hypothesis of drug abuse. The present study tested whether a compound natural reward that is known to increase DA utilization, environmental enrichment, would prevent the persistent expression of cocaine conditioned place preference (CPP) otherwise observed in food restricted rats, along with the mechanistic underpinnings. Because nearly all prior investigations of both food restriction and environmental enrichment effects on cocaine CPP were conducted in male rodents, both sexes were included in the present study. Results indicate that environmental enrichment curtailed the persistence of CPP expression, decreased signaling downstream of the D1R, and decreased the amplitude and frequency of spontaneous excitatory postsynaptic currents (EPSCs) in NAc MSNs of food restricted male, but not female, rats. The failure of environmental enrichment to significantly decrease food restriction-induced synaptic insertion of CP-AMPARs, and how this may accord with previous pharmacological findings that blockade of CP-AMPARs reverses behavioral effects of food restriction is discussed. In addition, it is speculated that estrous cycle-dependent fluctuations in DA release, receptor density and MSN excitability may obscure the effect of increased DA signaling during environmental enrichment, thereby interfering with development of the cellular and behavioral effects that enrichment produced in males.

Epidemiology of substance and opium use among adult residents of Tehran; a comprehensive report from Tehran cohort study (TeCS)

BACKGROUND

The prevalence and burden of substance and opium use have increased worldwide over the past decades. In light of rapid population changes in Tehran, we aimed to evaluate the prevalence of opium and other substance use among adult residents in Tehran, Iran.

METHOD

From March 2016 to March 2019, we utilized data from 8 296 participants in the Tehran Cohort Study recruitment phase (TeCS). We calculated the age-sex-weighted prevalence of substance use and the geographic distribution of substance use in Tehran. We also used logistic regression analysis to determine possible determinants of opium use.

RESULT

We analyzed data from 8 259 eligible participants with complete substance use data and the average age of participants was 53.7 ± 12.75 years. The prevalence of substance use was 5.6% (95% confidence interval [CI]: 4.6- 7.1%). Substance use was more common in males than females (Prevalence: 10.5% [95% CI: 8.6- 12.6%] vs. 0.5% [95% CI: 0.2- 1.2%], respectively). The age-sex weighted prevalence of substance use was 5.4% (95% CI: 4.6-7.1%). Moreover, opium was the most frequently used substance by 95.8% of substance users. Additionally, we found that male gender (Odds ratio [OR]: 12.1, P < 0.001), alcohol intake (OR: 1.3, P = 0.016), and smoking (OR: 8.5, P < 0.001) were independently associated with opium use.

CONCLUSIONS

We found that the prevalence of substance use in Tehran was 5.6%, and opium was the most frequently used substance. In addition, male gender, lower levels of education, alcohol, and tobacco consumption are the main risk factors for substance use in Tehran. Healthcare providers and policymakers can utilize our results to implement preventive strategies to minimize substance use in Tehran.

Fiduciary assignment as a potential intervention for substance use disorder: a retrospective chart review

Background: Assignment of fiduciaries to veterans with disability payments is an intervention thought to improve quality of life; however, in veterans who use substances, a proportion of these payments may be misspent on drugs and/or alcohol. While fiduciary assignment may reduce funds available to purchase substances, clinical efficacy of this intervention in the management of substance use disorders has not been rigorously demonstrated.Objectives: The purpose of this study is to evaluate changes in clinical status before and after fiduciary assignment.Methods: This was a retrospective chart review of 50 (44 male, 6 female) veterans who were assigned a fiduciary and determined to have a substance use disorder (SUD). SUD-related data including outpatient and inpatient treatment, toxicology testing, and measures of psychosocial functioning for the three years before and after fiduciary assignment were extracted and compared.Results: Veterans were found to have higher rates of any form of employment after fiduciary assignment (Wilcoxon, Signed Ranked S-statistic = 0.22, pr = 0.02). Two changes in measures of substance use were found after fiduciary assignment. There was a reduction in positive screens for heroin (tstatistic = -2.7, p = .01), but an increase in positive screens for fentanyl (t statistic = 2.53, p = .02). There were some potentially clinically but not statistically significant trends in increased adherence with mental health appointments, number of medical hospitalizations, and rates of employment post-fiduciary assignment.Conclusions: Understanding the clinical impact of fiduciary assignment for veteran's benefits is desirable but still pending at this time.

A Complex Interplay between Nutrition and Alcohol use Disorder: Implications for Breaking the Vicious Cycle

Approximately 16.5% of the United States population met the diagnostic criteria for substance use disorder (SUD) in 2021, including 29.5 million individuals with alcohol use disorder (AUD). Individuals with AUD are at increased risk for malnutrition, and impairments in nutritional status in chronic alcohol users can be detrimental to physical and emotional well-being. Furthermore, these nutritional deficiencies could contribute to the never-ending cycle of alcoholism and related pathologies, thereby jeopardizing the prospects of recovery and treatment outcomes. Improving nutritional status in AUD patients may not only compensate for general malnutrition but could also reduce adverse symptoms during recovery, thereby promoting abstinence and successful treatment of AUD. In this review, we briefly summarize alterations in the nutritional status of people with addictive disorders, in addition to the underlying neurobiological mechanisms and clinical implications regarding the role of nutritional intervention in recovery from alcohol use disorder.

Results from a Nationwide Evaluation Study of Labor Market-Integrative Health Promotion for the Unemployed: Impact of the JOBS Program Germany

Compared to the employed, the unemployed suffer from poorer health, especially in terms of mental health. At the same time, health promotion rarely reaches unemployed people. The "JOBS Program" is an intervention to promote health and labor market integration and has shown positive effects in the USA and Finland. In this confirmatory study, we investigated whether the JOBS Program achieves similar effects in Germany. We applied a randomized controlled trial to compare an intervention group (IVG) with a waiting control group (WCG) before (T0; N = 94) and shortly after (T1; n = 65) the intervention. Concerning our primary outcomes, the JOBS Program Germany was beneficial: Compared to the WCG, the regression estimated that the IVG had (1) a 2.736 scale point higher level of life satisfaction (p = 0.049), (2) a 0.337 scale point higher level of general health (p = 0.025), and (3) a 14.524 scale point higher level of mental well-being (p = 0.004). Although not statistically significant, job search-specific self-efficacy also appeared to be positively associated with the intervention. This study provides evidence of the effectiveness of JOBS Program on the abovementioned outcomes, including for older and long-term unemployed people, supporting the benefits of regular implementation of this program for a wide range of unemployed people in Germany.

Liens entre le statut tabagique et la situation vis-à-vis de l’emploi : analyse transversale de la cohorte CONSTANCES

This study aims to estimate the prevalence of tobacco use in 2017 and 2019 in the French population covered by the Régime Général d'Assurance Maladie according to employment status. From the French national CONSTANCES cohort, 18,008 randomly recruited volunteers aged between 18 and 69 years, affiliated to the Régime Général d'Assurance Maladie and enrolled in 2017, were included in the analysis. The prevalence of tobacco use according to employment status was estimated. Estimates of these prevalence data were calculated in 2017 and 2019 after correction for selection bias at inclusion and non-response at follow-up. In 2019, smoking prevalence was higher among unemployed people (29.2% among men and 20.7% among women) than among employed people (16.5% among men and 13.8% among women). Smoking prevalence was highest among those not in work for health reasons (38.5% among men and 35.8% among women). Smokers were more likely to be unemployed than non-smokers (OR 2.63 [95% confidence interval (CI): 1.79; 3.85] in men and OR 1.55 [95% CI: 1.08; 2.22] in women). Among men, the prevalence of employed people among light smokers (<10 cigarettes/day) significantly decreased between 2017 (87.1%) and 2019 (74.8%). These results underline the importance of reinforcing smoking prevention campaigns among the unemployed, particularly for health reasons.