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Oesterle TS, Bormann NL, Ochal DA, Arndt S, Breitinger SA. Transitioning Virtual-Only Group Therapy for Substance Use Disorder Patients to a Hybrid Model. Subst Abuse Rehabil 2024; 15:73-78. [PMID: 38681859 PMCID: PMC11055515 DOI: 10.2147/sar.s460024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/20/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Telehealth is associated with a myriad of benefits; however, little is known regarding substance use disorder (SUD) treatment outcomes when participants join group therapy sessions in a combination in-person and virtual setting (hybrid model). We sought to determine if treatment completion rates differed. Patients and Methods Policy changes caused by the COVID-19 pandemic created a naturalistic, observational cohort study at seven intensive outpatient (IOP) programs in rural Minnesota. Virtual-only delivery occurred 6/1/2020-6/30/2021, while hybrid groups occurred 7/1/2021-7/31/2022. Data was evaluated retrospectively for participants who initiated and discharged treatment during the study period. Participants were IOP group members 18 years and older who had a SUD diagnosis that both entered and discharged treatment during the 26-month period. A consecutive sample of 1502 participants (181-255 per site) was available, with 644 removed: 576 discharged after the study conclusion, 49 were missing either enrollment or discharge data, 14 transferred sites during treatment, and 5 initiated treatment before the study initiation. Helmert contrasts evaluated the impact of hybrid group exposure. Results A total of 858 individuals were included. Data was not from the medical chart and was deidentified preventing specific demographics; however, the overall IOP sample for 2020-2022, from which the sample was derived, was 29.8% female, and 64.1% were 18-40 years of age. For completed treatment, hybrid group exposure relative to virtual-only had a univariate odds ratio of 1.88 (95% CI: 1.50-2.41, p < 0.001). No significant difference was seen across IOP sites. Conclusion These results describe a novel hybrid group approach to virtual care for SUDs with outcome data not previously documented in the literature. While virtual treatment delivery can increase access, these results suggest a benefit is derived from including an in-person option. Further research is needed to identify how an in-person component may change dynamics and if it can be replicated in virtual-only models.
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Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Nicholas L Bormann
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Scott A Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Liu L, Zgoba KM. Examining a Triple Threat: The Intersection of Mental Health, Substance Use, and Re-entry of a Sample of Justice-Involved Persons. Adm Policy Ment Health 2024:10.1007/s10488-024-01347-5. [PMID: 38315266 DOI: 10.1007/s10488-024-01347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
Having a mental health (MH) or substance use (SU) issue can make the transition from prison to the community a challenging process. Despite this, few studies have quantified how justice-involved individuals with mental health issues only, substance use only, those with both struggles, and those with neither are uniquely affected. Using a sample of re-entering men who were released from twelve state prisons in the United States, we assessed the effects of having MH and SU issues on their drug use during re-entry. Furthermore, we examined their differing coping reactions to housing insecurity, joblessness, and family tension after release. The results demonstrated that respondents' risk of SU during re-entry was associated with MH and SU issues measured at release. Those with co-occurring MH and SU challenges were at the highest risk of SU during re-entry. Furthermore, challenging life situations during re-entry exerted an amplified effect on SU for respondents with both anxiety and SU issues. The findings suggest that post-incarcerated individuals with co-occurring MH and SU issues have the highest risk of SU, and their reaction to re-entry barriers is distinct from their peers. Quality services to address co-occurring MH and SU may be needed to facilitate a smooth transition from prison to the community.
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Affiliation(s)
- Lin Liu
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, FL, USA.
| | - Kristen M Zgoba
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, FL, USA
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3
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Dams GM, Ketchen BR, Burden JL, Smith NB. Effectiveness of residential treatment services for veterans with substance use disorders: A propensity score matching evaluation. Drug Alcohol Depend 2024; 255:111081. [PMID: 38211367 DOI: 10.1016/j.drugalcdep.2024.111081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Prior reviews of substance use disorder (SUD) treatment have found mixed support for residential level of care but are limited by methodology problems and the ethical concerns of randomizing patients with severe SUD to lower levels of care. METHODS The present study is the first to use a large archival SUD residential sample with a matched comparison group and one-year follow-up period to examine the benefits of residential treatment provided to adults clinically assessed as warranting SUD residential care. We used propensity score matching in our sample (N = 6177) of veterans with a SUD who were screened and accepted for Veterans Affairs (VA) SUD residential treatment between January 1st, 2019 and June 30th, 2019. RESULTS We found evidence that VA SUD residential treatment saves veteran lives with an average 66% all-cause mortality risk reduction during the study period (b = -1.09, exp(b) = 0.34, p <0.001). Medium-to-large residential pre- to post-treatment self-reported mental health and SUD symptom improvements (|SMDrobust| = 0.54-0.93) were sustained by one-year post-screening. These residential treatment improvements were significantly larger than estimated counterfactual outcomes across self-reported SUD and stress disorder symptoms at one-year post-screening (ps <0.001). We found mixed behavioral, service utilization, and other self-reported mental health outcomes. CONCLUSIONS We conclude that VA SUD residential treatment is an effective level of care for veterans warranting residential care particularly for SUD symptom improvements and reductions in mortality risk.
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Affiliation(s)
- Gregory M Dams
- Salem Veterans Affairs Medical Center, Salem, VA, United States; VA Program Evaluation and Resource Center, Menlo Park, CA, United States.
| | | | - Jennifer L Burden
- Department of Veterans Affairs, Veterans Health Administration, Salem, VA, United States
| | - Noelle B Smith
- Department of Psychiatry, Yale School of Medicine, Yale University, United States; VA Northeast Program Evaluation Center, West Haven, CT, United States
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4
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Parlier-Ahmad AB, Kelpin S, Martin CE, Svikis DS. Baseline Characteristics and Postdischarge Outcomes by Medication for Opioid Use Disorder Status Among Women with Polysubstance Use in Residential Treatment. Womens Health Rep (New Rochelle) 2023; 4:617-626. [PMID: 38145229 PMCID: PMC10739697 DOI: 10.1089/whr.2023.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/26/2023]
Abstract
Background Within residential treatment, medication for opioid use disorder (MOUD) is rarely offered, so little is known about group differences by MOUD status. This study characterizes samples of women receiving and not receiving MOUD and explores postdischarge outcomes. Methods This is a secondary exploratory analysis of a residential clinical trial comparing women receiving treatment as usual (TAU) with those who also received computer-based training for cognitive behavioral therapy (CBT4CBT). Participants were N = 41 adult women with substance use disorder (SUD) who self-reported lifetime polysubstance use. Because 59.0% were prescribed MOUD (MOUD n = 24, no MOUD n = 17), baseline variables were compared by MOUD status; outcomes at 12 weeks postdischarge were compared by MOUD status and treatment condition using chi square and Mann-Whitney U tests. Results Participants were middle-aged (41.7 ± 11.6 years) and non-Latinx Black (80.4%). Most used substances in the No MOUD group were alcohol, cocaine, and cannabis, and in the MOUD group, most used substances were opioids, cannabis, and cocaine. Women in the MOUD group tended to have more severe SUD. Postdischarge substance use recurrence rates were twice as high in the MOUD group than in the No MOUD group. Among the women in the No MOUD group, those in the CBT4CBT condition increased the number of coping strategies twice as much as those receiving TAU. Conclusion Postdischarge substance use recurrence differed by MOUD status. CBT4CBT may be a helpful adjunct to personalized residential SUD treatment. The parent study is registered at [www.clinicaltrials.gov (ClinicalTrials.gov identifier: NCT03678051)].
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Affiliation(s)
- Anna Beth Parlier-Ahmad
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sydney Kelpin
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dace S. Svikis
- Department of Psychology, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
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Bourdon JL, Judson S, Caporaso G, Wright MF, Fields T, Vadhan NP, Morgenstern J. Adapting, Implementing, and Maintaining a Group Cognitive Behavioral Therapy Program at an Inpatient Addiction Treatment Facility. Subst Abuse Rehabil 2023; 14:119-130. [PMID: 37954500 PMCID: PMC10637231 DOI: 10.2147/sar.s433523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
Background Quality training is an oft-cited barrier to effective implementation and ongoing delivery of high-quality evidence-based practice (EBP) across fields. This is especially true in the addiction field, but there is little cited evidence for optimal methods to improve EBP in inpatient addiction facilities with minimal resources. Objective The current paper focuses on evaluating the state of our facility's group CBT manual and clinical training on the manual in a "realistic" (ie, non-RCT, non-grant-funded) inpatient addiction treatment setting. Methods Five full-time clinicians volunteered to take part in the study (woman = 60%; Mage = 36.20 years). The study involved a mix of semi-structured interviews and surveys designed to measure seven outcomes (barriers, feasibility, useability, appropriateness, acceptability, burden, trialability). Results Three themes emerged from the data that impacted the group CBT manual: training, timing, and functionality. Addressing these themes allowed for a new, optimal manual and training procedure to be put into place. Conclusion The current study highlights that under-resourced inpatient addiction facilities can still methodically utilize implementation approaches to study their EBP, namely CBT. Such an approach will ensure that the highest quality care is being delivered to patients and actively addresses known training barriers that prevent proper EBP delivery.
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Affiliation(s)
- Jessica L Bourdon
- Center for Addiction Science, Wellbridge Addiction Treatment and Research, Calverton, NY, USA
| | - Sidney Judson
- Center for Addiction Science, Wellbridge Addiction Treatment and Research, Calverton, NY, USA
| | - Gabriella Caporaso
- Center for Addiction Science, Wellbridge Addiction Treatment and Research, Calverton, NY, USA
| | - Monica F Wright
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Taylor Fields
- Center for Addiction Science, Wellbridge Addiction Treatment and Research, Calverton, NY, USA
| | - Nehal P Vadhan
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USA
| | - Jon Morgenstern
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USA
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Caluzzi G, MacLean S, Gray R, Skattebol J, Neale J, Bryant J. 'I just wanted a change, a positive change': Locating hope for young people engaged with residential alcohol and drug services in Victoria, Australia. Sociol Health Illn 2023; 45:1691-1708. [PMID: 37278252 DOI: 10.1111/1467-9566.13680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
In this article, we investigate young people's involvement with residential alcohol and other drug (AOD) services as part of their broader engagement with hope. This study draws on qualitative interviews conducted with 20 young people aged 17-23 from Victoria, Australia, who were either in, or had recently left, residential AOD services. Interviews explored their experiences with AOD services and included questions about their hopes for the future. We found hope located in social relationships, productive discourses and AOD settings themselves. Hope also presented differently according to the external resources young people had available to them, giving some young people greater capacity to action their hoped-for futures than others. Given many young people seek reimagined futures as part of their use of residential AOD services, this creates a valuable opportunity for services to help shape achievable hopes and boost service engagement. We suggest that hope can materialise in a variety of ways but caution against relying on it as a motivational strategy without providing young people with other resources. A more sustainable narrative of hope may require a solid foundation of resources, allowing young people with AOD problems to gain a sense of control over their lives and their imagined futures.
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Affiliation(s)
- Gabriel Caluzzi
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah MacLean
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia
- School of Social Work and Social Policy, La Trobe University, Melbourne, Victoria, Australia
| | - Rebecca Gray
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jen Skattebol
- Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanne Neale
- Addictions Department, King's College London, London, UK
| | - Joanne Bryant
- School of Social Science, University of New South Wales, Sydney, New South Wales, Australia
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7
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Walter ZC, Carlyle M, Kerswell N, Mefodeva V, Nixon RDV, Cobham VE, Hides L. Study protocol: implementing and evaluating a trauma-informed model of care in residential youth treatment for substance use disorders. Front Psychiatry 2023; 14:1169794. [PMID: 37840800 PMCID: PMC10572352 DOI: 10.3389/fpsyt.2023.1169794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Comorbidity between Substance Use Disorders and trauma/post-traumatic stress disorder (PTSD) is common, particularly within residential treatment services. Comorbidity is associated with poorer treatment retention and treatment outcomes. Integrated treatment approaches are increasingly recommended but are still under examined in residential treatment services. This study will implement and evaluate a novel model of trauma-informed care (TIC) in a youth (18-35 years) residential substance use treatment service. Methods and analysis A single-armed, phase 1 implementation trial will be conducted in one residential treatment service. The model, co-developed with staff, incorporates: (i) workforce development in TIC through staff training and clinical supervision; adaptions to the service (ii) policies, procedures, and physical settings and (iii) treatment program adaptions (in delivery style and content) to be more trauma-informed; (iv) client screening and feedback for trauma and PTSD at service entry; and (v) the provision of support, referral and/or trauma-focused therapy to those with PTSD. Service outcomes will include adherence to the TIC model and client treatment completion. Client substance use and mental health measures will be collected at service entry, and 1-, 3-, 6- and 12-months follow up. Staff outcomes, including workplace satisfaction, burnout, and fatigue, as well as perceptions and confidence in delivering TIC will be collected at baseline, and at 3-, 6-, 12- and 18-months following training in the model. The sustainability of the delivery of the TIC model of care will be evaluated for 12 months using service and staff outcomes. Ethics and dissemination The study has received ethical approval by the University of Queensland (Approval number: 2020000949). The results will be disseminated through publication in a peer-reviewed scientific journal, presentations at scientific conferences, and distributed via a report and presentations to the partner organization.Clinical trial registration: ACTRN12621000492853.
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Affiliation(s)
- Zoe C. Walter
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Molly Carlyle
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Nick Kerswell
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Valeriya Mefodeva
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
| | - Reg D. V. Nixon
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Adelaide, SA, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Vanessa E. Cobham
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Children’s Health Queensland, Child and Youth Mental Health Service, Brisbane, QLD, Australia
| | - Leanne Hides
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- National Center for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia
- Lives Lived Well, Brisbane, QLD, Australia
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Whitten T, Cale J, Nathan S, Hayen A, Williams M, Shanahan M, Ferry M. Duration of stay and rate of subsequent criminal conviction and hospitalisation for substance use among young people admitted to a short-term residential program. Drug Alcohol Rev 2023; 42:1450-1460. [PMID: 37042736 DOI: 10.1111/dar.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION This study examined the association between program duration and rate of criminal conviction and hospitalisation for substance use up to 15 years later among young people admitted to a short-term residential program for drug and alcohol use. METHODS Data were derived from linked administrative records of all clients referred to a modified therapeutic community for young people from January 2001 to December 2016 in New South Wales, Australia (n = 3059). Cox proportional hazards regression analyses examined the rate of conviction (separately for any offence, violent offence, non-violent offence and administrative offence) and hospitalisation for substance use, up to 15 years post-program among young people who attended treatment for 1-29 days, 30-59 days, 60-89 days and 90-120 days. RESULTS Thirty days or more in treatment was independently associated with a lower rate of conviction for any offence and a non-violent offence, as well as hospitalisation for substance use, while 60 days or more was associated with a lower rate of conviction for a violent and administrative offence, relative to those who spent 1-29 days in the program. Additional months in the program were also associated with reduced rates of conviction and hospitalisation, although 90-120 days appeared to confer no additional benefits than 60-89 days. DISCUSSION AND CONCLUSIONS At least 60 days may be the minimum duration needed for short-term, therapeutic community programs to reduce the risk of conviction across all crime types and hospitalisation for substance use.
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Affiliation(s)
- Tyson Whitten
- Center for Law and Justice, Charles Sturt University, Port Macquarie, Australia
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
| | - Jesse Cale
- School of Criminology and Criminal Justice, Griffith University, Gold Coast, Australia
| | - Sally Nathan
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Megan Williams
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Saunders KRK, McGuinness E, Barnett P, Foye U, Sears J, Carlisle S, Allman F, Tzouvara V, Schlief M, Vera San Juan N, Stuart R, Griffiths J, Appleton R, McCrone P, Rowan Olive R, Nyikavaranda P, Jeynes T, K T, Mitchell L, Simpson A, Johnson S, Trevillion K. A scoping review of trauma informed approaches in acute, crisis, emergency, and residential mental health care. BMC Psychiatry 2023; 23:567. [PMID: 37550650 PMCID: PMC10405430 DOI: 10.1186/s12888-023-05016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023] Open
Abstract
Experiences of trauma in childhood and adulthood are highly prevalent among service users accessing acute, crisis, emergency, and residential mental health services. These settings, and restraint and seclusion practices used, can be extremely traumatic, leading to a growing awareness for the need for trauma informed care (TIC). The aim of TIC is to acknowledge the prevalence and impact of trauma and create a safe environment to prevent re-traumatisation. This scoping review maps the TIC approaches delivered in these settings and reports related service user and staff experiences and attitudes, staff wellbeing, and service use outcomes.We searched seven databases (EMBASE; PsycINFO; MEDLINE; Web of Science; Social Policy and Practice; Maternity and Infant Care Database; Cochrane Library Trials Register) between 24/02/2022-10/03/2022, used backwards and forwards citation tracking, and consulted academic and lived experience experts, identifying 4244 potentially relevant studies. Thirty-one studies were included.Most studies (n = 23) were conducted in the USA and were based in acute mental health services (n = 16). We identified few trials, limiting inferences that can be drawn from the findings. The Six Core Strategies (n = 7) and the Sanctuary Model (n = 6) were the most commonly reported approaches. Rates of restraint and seclusion reportedly decreased. Some service users reported feeling trusted and cared for, while staff reported feeling empathy for service users and having a greater understanding of trauma. Staff reported needing training to deliver TIC effectively.TIC principles should be at the core of all mental health service delivery. Implementing TIC approaches may integrate best practice into mental health care, although significant time and financial resources are required to implement organisational change at scale. Most evidence is preliminary in nature, and confined to acute and residential services, with little evidence on community crisis or emergency services. Clinical and research developments should prioritise lived experience expertise in addressing these gaps.
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Affiliation(s)
- Katherine R K Saunders
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK.
| | - Elizabeth McGuinness
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, & Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Jessica Sears
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sophie Carlisle
- Section of Women's Mental Health, King's College London, London, UK
| | - Felicity Allman
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Vasiliki Tzouvara
- Care for Long Term Conditions Research Division, King's College London, London, UK
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Norha Vera San Juan
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Ruth Stuart
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Jessica Griffiths
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
- School of Health Sciences, University of Greenwich, London, UK
| | - Rachel Rowan Olive
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Tamar Jeynes
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - T K
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Lizzie Mitchell
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Kylee Trevillion
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
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Mustapha SZ, Ahmad Y, Aziz NA, Abd Hamid SNF. Cure & Care 1Malaysia Clinics: Measuring the Effectiveness via Dyads Lens Involving Receivers and Providers. J Patient Exp 2023; 10:23743735231179070. [PMID: 37332831 PMCID: PMC10272645 DOI: 10.1177/23743735231179070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Drug treatment and rehabilitation programs are one of the initiatives to alleviate the global epidemic of drug addiction. The efforts were undertaken by everyone, particularly the government. However, the rising number of drug relapses among patients or clients ponders the effectiveness of the drug treatment and rehabilitation programs implemented in the country. This paper aims to study the drug relapse prevention initiatives and the effectiveness of the center in dealing with drug addiction issues. A case study of 4 drug treatment and rehabilitation centers, namely Cure & Care 1Malaysia Clinics in Selangor, Malacca, Penang, and Kelantan, was selected. In-depth interviews were conducted with 37 participants-26 clients and 11 providers, and the data were analyzed using thematic analysis and NVivo version 12. The findings indicate that relapse prevention initiatives are a signal for the effectiveness of the center to reduce drug relapse cases. The implementation of drug treatment and rehabilitation programs was effective based on key aspects consisting of (1) knowledge and life skills learned; (2) staff reception; (3) individual changes; and (4) client acceptance. Therefore, by experiencing relapse prevention activities, it helps to improve the effectiveness of the implementation of drug treatment and rehabilitation programs.
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Affiliation(s)
- Siti Zulaikha Mustapha
- Faculty of Administrative Science and Policy Studies, Universiti Teknologi MARA Kelantan, Machang, Malaysia
| | - Yarina Ahmad
- Faculty of Administrative Science and Policy Studies, Institute for Biodiversity and Sustainable Development, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Nur Amalina Aziz
- Faculty of Business and Management, Universiti Teknologi MARA Segamat, Malaysia
| | - Siti Nur Fathanah Abd Hamid
- Faculty of Administrative Science and Policy Studies, Institute for Biodiversity and Sustainable Development, Universiti Teknologi MARA, Shah Alam, Malaysia
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11
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Winder GS, Clifton EG. Alcohol use disorder treatment delivered outside hepatology clinic. Clin Liver Dis (Hoboken) 2023; 21:134-137. [PMID: 37274949 PMCID: PMC10238045 DOI: 10.1097/cld.0000000000000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/05/2022] [Indexed: 06/07/2023] Open
Affiliation(s)
- Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin G. Clifton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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12
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Piché F, Daneau C, Plourde C, Girard S, Romain AJ. Characteristics and impact of physical activity interventions during substance use disorder treatment excluding tobacco: A systematic review. PLoS One 2023; 18:e0283861. [PMID: 37099488 PMCID: PMC10132651 DOI: 10.1371/journal.pone.0283861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/19/2023] [Indexed: 04/27/2023] Open
Abstract
Substance use disorder is a worldwide issue that entails negative health and physical activity is a promising complementary therapy for alleviating the consequences. The objective of this reviews is to characterize physical activity interventions offered in the literature and explore their effects during treatment for people with substance use disorders with excluding studies focusing only on tobacco use. A systematic search of seven databases on articles including a physical activity intervention during a treatment for substance use disorder was done and an examination of the presence of bias was performed. A total of 43 articles including 3135 participants were identified. Most studies were randomized controlled trial (81%), followed by pre-post design (14%) and cohort studies (5%). The most common physical activity intervention identified was of moderate intensity, 3 times per week (≈ 1 hour) for 13 weeks. Cessation/reduction of substance use was the most studied outcome (21 studies, 49%), and 75% showed a decrease in substance use following physical activity intervention. Aerobic capacity was the second most studied effect (14 studies, 33%), with more than 71% of studies showing improvement. Twelve studies (28%) reported a decrease of depressive symptoms. Physical activity interventions in a treatment for substance use disorder seem to be a promising, but more methodologically rigorous scientific studies are needed.
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Affiliation(s)
- Florence Piché
- Department of Human Kinetics, University of Quebec in Trois-Rivières, Trois-Rivières, Québec, Canada
- Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada
| | - Catherine Daneau
- Department of Human Kinetics, University of Quebec in Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Chantal Plourde
- Department of Psychoeducation, University of Quebec in Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Stéphanie Girard
- Department of Human Kinetics, University of Quebec in Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Ahmed Jérôme Romain
- Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada
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13
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Allen L, Sharbaugh M, Austin A, Cole ES, Barnes A, Clark S, Crane D, Cunningham P, Fry C, Gordon A, Hammerslag L, Idala D, Kennedy S, Krishnan S, Lanier P, Mahakalanda S, Mauk R, McDuffie MJ, Mohamoud S, Talbert J, Zivin K, Donohue JM. Use of residential opioid use disorder treatment among Medicaid enrollees in nine states. J Subst Use Addict Treat 2023; 149:209034. [PMID: 37059269 DOI: 10.1016/j.josat.2023.209034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/28/2022] [Accepted: 03/27/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Residential treatment is a key component of the opioid use disorder care continuum, but research has not measured well the differences in its use across states at the enrollee level. METHODS This cross-sectional observational study used Medicaid claims data from nine states to document the prevalence of residential treatment for opioid use disorder and to describe the characteristics of patients receiving care. For each patient characteristic, chi-square and t-tests tested for differences in the distribution between individuals who did and did not receive residential care. RESULTS Among 491,071 Medicaid enrollees with opioid use disorder, 7.5 % were treated in residential facilities in 2019, though this number ranged widely (0.3-14.6 %) across states. Residential patients were more likely to be younger, non-Hispanic White, male, and living in an urban area. Although residential patients were less likely than those without residential care to be eligible for Medicaid through disability, diagnoses for comorbid conditions were more frequently observed among residential patients. CONCLUSIONS Results from this large, multi-state study add context to the ongoing national conversation around opioid use disorder treatment and policy, providing a baseline for future work.
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Affiliation(s)
| | | | - Anna Austin
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Evan S Cole
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | - Carrie Fry
- Vanderbilt University, Nashville, TN, USA
| | | | | | | | | | | | - Paul Lanier
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | - Kara Zivin
- University of Michigan, Ann Arbor, MI, USA
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14
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MacKenzie N, Smith DJ, Lawrie SM, M Rome A, McCartney D. Substance use, risk behaviours and well-being after admission to a quasi-residential abstinence-based rehabilitation programme: 4-year follow-up. BJPsych Open 2023; 9:e52. [PMID: 36908252 PMCID: PMC10043999 DOI: 10.1192/bjo.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Tackling Scotland's drug-related deaths and improving outcomes from substance misuse treatments, including residential rehabilitation, is a national priority. AIMS To analyse and report outcomes up to 4 years after attendance at a substance misuse residential rehabilitation programme (Lothians and Edinburgh Abstinence Programme). METHOD In total, 145 participants were recruited to this longitudinal quantitative cohort study of an abstinence-based residential rehabilitation programme based on the therapeutic community model; 87 of these participants were followed up at 4 years. Outcomes are reported for seven subsections of the Addiction Severity Index-X (ASI-X), together with frequency of alcohol use, heroin use, injecting drug use and rates of abstinence from substances of misuse. RESULTS Significant improvement in most outcomes at 4 years compared with admission scores were found. Completing the programme was associated with greater rates of abstinence, reduced alcohol use and improvements in alcohol status score (Mann-Whitney U = 626, P = 0.013), work satisfaction score (U = 596, P = 0.016) and psychiatric status score (U = 562, P = 0.007) on the ASI-X, in comparison with non-completion. Abstinence rates improved from 12% at baseline to 48% at 4 years, with the rate for those completing the programme increasing from 14.5% to 60.7% (χ2(2, 87) = 9.738, P = 0.002). Remaining abstinent from substances at follow-up was associated with better outcomes in the medical (U = 540, P < 0.001), psychiatric (U = 273.5, P < 0.001) and alcohol (U = 322.5, P < 0.001) subsections of the ASI-X. CONCLUSIONS Attending this abstinence-based rehabilitation programme was associated with positive changes in psychological and social well-being and harm reduction from substance use at 4-year follow-up, with stability of change from years 1 to 4.
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Affiliation(s)
- Nina MacKenzie
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; and NHS Lothian, Edinburgh, UK
| | - Daniel J Smith
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stephen M Lawrie
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; and NHS Lothian, Edinburgh, UK
| | | | - David McCartney
- Lothian and Edinburgh Abstinence Programme, NHS Lothian, Edinburgh, UK
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15
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De Salis HF, Martin R, Mansoor Z, Newton-Howes G, Bell E. A realist review of residential treatment for adults with substance use disorder. Drug Alcohol Rev 2023; 42:827-842. [PMID: 36747370 DOI: 10.1111/dar.13615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 02/08/2023]
Abstract
ISSUES Completion of residential treatment for substance use disorder (SUD) relates to improvements in substance use and mental health. Findings from systematic reviews have been equivocal about which interventions work best for clients. There has been limited attention to the theories that explain the effectiveness of residential treatment. APPROACH We conducted a realist review of the literature to identify program theories that would explain successful and unsuccessful outcomes from residential treatment for SUD. The unit of analysis was context-mechanism-outcome (CMO). Inclusion criteria were studies of residential treatment of more than 30 days for adults with SUD. Pharmacological studies were excluded. KEY FINDINGS We identified 24 studies from 5748 screened. The studies were from settings comprising Indigenous programs, faith-based programs, psycho-social interventions and therapeutic communities and were conducted in North America, Scandinavia, Continental Europe and Australasia. We chose six CMO configurations as the best explanations for outcomes from residential treatment. Theories that best explained the mechanisms of change were the need to belong, meaning in life, and self-determination theory. IMPLICATIONS Previous research has noted similar outcomes from different residential treatment interventions, but has not been able to explain these similarities. In contrast, our findings suggest that the outcomes can be explained by causal mechanisms that apply across all programs, regardless of the philosophy of treatment. CONCLUSION We identified six CMO configurations whose mechanisms of change could be explained by three overarching theories-the need to belong, meaning in life and self-determination theory. The findings apply across ethnicities and genders.
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Affiliation(s)
- Henry F De Salis
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Rachelle Martin
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand.,Burwood Academy Trust, Burwood Hospital, Christchurch, New Zealand
| | - Zara Mansoor
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.,Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
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16
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Snaychuk LA, Hirst SA, Basedow CA. Inpatient treatment for substance use disorders: reductions in substance cravings, anxiety, and depressive symptoms. Journal of Substance Use 2023. [DOI: 10.1080/14659891.2023.2173095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Sydney A. Hirst
- Department of Research, EHN Western Canada, Nanaimo, BC, Canada
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17
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Fox DJ, Hanes D. Prevalence and Correlates of Unmet Mental Health Services Need in Adolescents With Major Depressive Episode in 2019: An Analysis of National Survey on Drug Use and Health Data. J Adolesc Health 2023; 72:182-188. [PMID: 36424335 DOI: 10.1016/j.jadohealth.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/04/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Mental health (MH) crises in adolescence can derail development, possibly leading to poorer health outcomes in young adulthood. According to recent estimates, approximately half of US children have unmet MH need, with increased odds when uninsured or Hispanic. The aims of this study were to update estimates of MH services need and use in the US adolescent (12- 17 years) and to reassess previously identified associations between insurance status, demographic characteristics, MH need and use, and unmet need, using data from the National Survey of Drug Use and Health (NSDUH; 2019). METHODS Adolescents aged 12-17 years were included from the NSDUH. Logistic regressions were performed to assess associations of race and insurance with outcomes of past-year major depressive episode (MDE) and unmet MH need. Adjustments were made for age, sex, and income. RESULTS Individuals of multiple races, females, and users of alcohol, marijuana, and illicit drugs had increased odds of MDE, while Black adolescents and the privately insured had decreased odds. Hispanic adolescents, people of multiple races, and users of alcohol and illicit drug had increased odds for unmet need. DISCUSSION We estimate that 15.8% of all US adolescents had an MDE and that 45.8% of these adolescents with MDE went without MH care in 2019. We found very limited support for associations of race and insurance status with past-year MDE or unmet MH need, although this may be due to the small number of uninsured adolescents sampled in 2019. Longitudinal data are needed to assess severity of MH needs and appropriateness of care.
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Affiliation(s)
- Devon J Fox
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon.
| | - Douglas Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon
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18
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Thomas S, Cotroneo S, Pham D, Kalogeropoulos R, Tyler J, Arunogiri S. Social work in alcohol and other drug service navigation: supporting social complexity in dual diagnosis. ADD 2023. [DOI: 10.1108/add-10-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose
Many people with dual diagnosis present with social complexity that impedes service access. The role of social work support in such service navigation is poorly understood. This study aims to characterise client presentations to an Australian telephone-based social work alcohol and other drug (AOD) service navigation and linkage program, with consideration of presentation complexity compared between those clients who present with or without self-reported mental health (MH) concerns and a history of MH diagnoses, to identify differences in baseline characteristics, and linkage outcomes.
Design/methodology/approach
A retrospective audit was conducted of routinely collected clinical information from a six-month period, selected to capture the social and health challenges experienced during the mid-pandemic period (mid-2021) in Victoria, Australia, during which a number of lockdowns resulted in a reliance on telephone-based services. The audit focused on client and presentation characteristics, and compared clients with and without a history of co-occurring MH and AOD concerns.
Findings
It was found that three in four people accessing an Australian telephone-based AOD service navigation and linkage program presented with dual diagnosis. Individuals with dual diagnosis required more support from the service compared to those without a co-occurring MH disorder; but overall, were just as likely to achieve a successful linkage to services, when offered holistic, long-term social work support.
Originality/value
This study focused on the role of social workers in this service navigation program in supporting individuals with complexity. It also highlights the challenges in operationalising social complexity factors alongside clinical MH and AOD diagnoses, and points to the need for further research to guide future service development for this vulnerable client group.
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19
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Tisdale C, Leung J, de Andrade D, Hides L. What Client Demographic, Substance Use, Mental Health, Treatment, and Psychological Variables Predict Residential Treatment Completion for Substance Use Disorders? Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-022-01002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AbstractResidential treatment is a common option for individuals with moderate to severe substance use disorders. In a cohort of individuals who accessed residential treatment, we investigated client demographic, substance use, mental health, treatment, and psychological predictors of treatment completion. Participants were a retrospective cohort of 1056 (15–69 years) individuals admitted to residential treatment facilities across Queensland, Australia, from January 2014 to December 2016. Participant characteristic information was obtained at admission, including the Depression Anxiety Stress Scale 21 (DASS-21). A multiple logistic regression model was conducted with treatment completion as the outcome. The overall rate of treatment completion was 14.3%. Mild to moderate (aOR = 0.48 [0.28–0.84], p = .010) and severe to extremely severe (aOR = 0.35 [0.17–0.74], p = .006) stress on the DASS-21 at service entry was significantly associated with a lower likelihood of treatment completion. Participants with higher levels of stress at service entry were less likely to complete treatment, representing a missed opportunity to provide targeted support during high-risk periods for individuals with substance use disorders. Further research investigating the nature and causes of stress in-between, during, and following presentations to residential treatment is needed.
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20
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Tardelli VS, Berro LF, Gerra G, Tadonio L, Bisaga A, Fidalgo TM. Prescription psychostimulants for cocaine use disorder: A review from molecular basis to clinical approach. Addict Biol 2023; 28:e13271. [PMID: 37016755 PMCID: PMC10499006 DOI: 10.1111/adb.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
Cocaine use is a public health concern in many countries worldwide, particularly in the Americas and Oceania. Overdose deaths involving stimulants, such as cocaine, have been increasing markedly in North America, especially with concurrent opioid involvement. To date, no pharmacological treatment is available to treat stimulant (including cocaine) use disorders. Prescription psychostimulants (PPs) could be useful to treat cocaine use disorder (CUD) as they share the pharmacological effects with cocaine, as evidenced by a recent meta-analysis that assessed 38 randomized clinical trials (RCTs). PPs were found to promote sustained abstinence and reduce drug use in patients with CUD. The aim of this paper is to provide a narrative review of the clinical pharmacology of PPs and comment on the current stage of evidence supporting PPs to treat CUD. We also propose a model of care that integrates PPs with evidence-based psychosocial interventions (such as cognitive-behavioural therapy [CBT] and contingency management [CM]), a harm reduction approach and case management with social support.
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Affiliation(s)
- Vitor S. Tardelli
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, SP, Brazil
- Translational Addiction Research Laboratory, Center for Addiction and Mental Health, Toronto, ON, Canada
| | - Lais F. Berro
- Department of Psychiatry and Human Behavior, University of Mississipi Medical Center, Jackson, MS, USA
| | - Gilberto Gerra
- Mental Health Department, Azienda Unitá Sanitaria Locale, Parma, Italy
| | - Leonardo Tadonio
- Mental Health Department, Azienda Unitá Sanitaria Locale, Parma, Italy
| | - Adam Bisaga
- The Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - Thiago M. Fidalgo
- Departamento de Psiquiatria, Universidade Federal de Sao Paulo (Unifesp), Sao Paulo, SP, Brazil
- Young Leaders Program from the National Academy of Medicine, Brazil
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Mefodeva V, Carlyle M, Walter Z, Chan G, Hides L. Polysubstance use in young people accessing residential and day-treatment services for substance use: substance use profiles, psychiatric comorbidity and treatment completion. Addiction 2022; 117:3110-3120. [PMID: 35851706 PMCID: PMC9804256 DOI: 10.1111/add.16008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/27/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS People with substance use disorders (SUDs) frequently present to treatment with polysubstance use and mental health comorbidities. Different combinations of substance use and mental health problems require different treatment approaches. Our study aimed to: (i) identify the shared substance use classes among young people at treatment admission, (ii) determine which mental health symptoms, quality of life (QoL) and service types were associated with the identified substance use classes, and (iii) prospectively determine which substance use classes and service types were more likely to complete treatment. DESIGN Cross-sectional and prospective study using service and outcome data. SETTING Substance use treatment services in Queensland and New South Wales, Australia. PARTICIPANTS De-identified service and outcome measure data were extracted from the files of 744 clients aged 18-35 years (48% male) admitted into seven residential and four day-treatment programmes. MEASUREMENTS Substance use and severity among tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, opioids, sedatives and inhalants. Other variables included: depression, anxiety, post-traumatic stress and psychotic symptoms, as well as QoL. FINDINGS Latent class analysis identified three polysubstance use classes: wide-ranging polysubstance users (WRPU; 22.45%), primary amphetamine users (56.45%) and alcohol and cannabis users (21.10%). The WRPU class had higher odds of psychotic symptoms than the alcohol and cannabis use class [odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.11-1.11]; and double the odds of residential programme enrolment than those in the amphetamine use class (OR = 2.35; 95% CI = 1.50-3.68). No other class differences on mental health or QoL variables were found. Clients enrolled in day-programmes had higher odds of completing treatment. CONCLUSIONS There appear to be high levels of polysubstance use among young people entering substance use treatment in Australia. Wide-ranging polysubstance users were more likely to report psychotic symptoms and be enrolled into a residential programme than primary amphetamine users and alcohol and cannabis users.
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Affiliation(s)
- Valeriya Mefodeva
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Molly Carlyle
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Zoe Walter
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Gary Chan
- National Centre for Youth Substance Use Research (NCYSUR)University of QueenslandBrisbaneQueenslandAustralia
| | - Leanne Hides
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia,National Centre for Youth Substance Use Research (NCYSUR)University of QueenslandBrisbaneQueenslandAustralia
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22
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Cole ES, Allen L, Austin A, Barnes A, Chang CCH, Clark S, Crane D, Cunningham P, Fry CE, Gordon AJ, Hammerslag L, Idala D, Kennedy S, Kim JY, Krishnan S, Lanier P, Mahakalanda S, Mauk R, McDuffie MJ, Mohamoud S, Talbert J, Tang L, Zivin K, Donohue JM. Outpatient follow-up and use of medications for opioid use disorder after residential treatment among Medicaid enrollees in 10 states. Drug Alcohol Depend 2022; 241:109670. [PMID: 36332591 PMCID: PMC10756712 DOI: 10.1016/j.drugalcdep.2022.109670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Follow-up after residential treatment is considered best practice in supporting patients with opioid use disorder (OUD) in their recovery. Yet, little is known about rates of follow-up after discharge. The objective of this analysis was to measure rates of follow-up and use of medications for OUD (MOUD) after residential treatment among Medicaid enrollees in 10 states, and to understand the enrollee and episode characteristics that are associated with both outcomes. METHODS Using a distributed research network to analyze Medicaid claims data, we estimated the likelihood of 4 outcomes occurring within 7 and 30 days post-discharge from residential treatment for OUD using multinomial logit regression: no follow-up or MOUD, follow-up visit only, MOUD only, or both follow-up and MOUD. We used meta-analysis techniques to pool state-specific estimates into global estimates. RESULTS We identified 90,639 episodes of residential treatment for OUD for 69,017 enrollees from 2018 to 2019. We found that 62.5% and 46.9% of episodes did not receive any follow-up or MOUD at 7 days and 30 days, respectively. In adjusted analyses, co-occurring mental health conditions, longer lengths of stay, prior receipt of MOUD or behavioral health counseling, and a recent ED visit for OUD were associated with a greater likelihood of receiving follow-up treatment including MOUD after discharge. CONCLUSIONS Forty-seven percent of residential treatment episodes for Medicaid enrollees are not followed by an outpatient visit or MOUD, and thus are not following best practices.
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Affiliation(s)
- Evan S Cole
- University of Pittsburgh, A616, 130 DeSoto Street, Pittsburgh, PA 15261, USA
| | | | - Anna Austin
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Paul Lanier
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | - Lu Tang
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Kara Zivin
- University of Michigan, Ann Arbor, MI, USA
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23
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José Félix Junior I, Paula Gonçalves Donate A, Regina Noto A, Carlos Fernandes Galduróz J, Maria Simionato N, Sátiro Opaleye E. Mindfulness-based Interventions in inpatient treatment for SUDs: a systematic review. Addict Behav Rep 2022. [DOI: 10.1016/j.abrep.2022.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/21/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
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Quinn CA, Walter ZC, de Andrade D, Dingle G, Haslam C, Hides L. Controlled Trial Examining the Strength-Based Grit Wellbeing and Self-Regulation Program for Young People in Residential Settings for Substance Use. Int J Environ Res Public Health 2022; 19:13835. [PMID: 36360714 PMCID: PMC9657698 DOI: 10.3390/ijerph192113835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
This cohort-controlled trial examined whether the 12-session Grit Wellbeing and Self-regulation Program enhanced the treatment outcomes of young people accessing residential alcohol and other drug (AOD) treatment. Grit focuses on increasing wellbeing and reducing substance use and mental health problems by building self-regulation skills, strengths, social connections, and health behaviours. Participants were 194 (66% male, Mage 27.40) young people (aged 18-35 years) accessing a six-week residential treatment program for substance use. Participants received standard treatment, or standard treatment plus Grit (two sessions/week for six weeks). The primary outcome was substance use, measured as: (i) global substance use and (ii) alcohol, methamphetamine, and cannabis use involvement. Secondary outcomes included wellbeing, depression, anxiety, and vocational engagement. Participants were assessed at baseline, and 6-weeks (secondary outcomes only), 3-months, 6-months, and 12-months post-program enrolment. Results revealed that both groups showed a significant improvement in all outcomes at three months, and improvements were maintained at 6- and 12-month follow-ups. The Grit group had a larger reduction in methamphetamine and cannabis use involvement compared to the control group. This study presents promising evidence that a six-week residential program can achieve improvements in AOD use, depression, anxiety, wellbeing and vocational engagement. Further, targeting self-regulation may enhance such programs.
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Affiliation(s)
- Catherine A. Quinn
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Zoe C. Walter
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Dominique de Andrade
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, Deakin University, Melbourne 3125, Australia
| | - Genevieve Dingle
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Catherine Haslam
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
| | - Leanne Hides
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane 4072, Australia
- School of Psychology, The University of Queensland, Brisbane 4072, Australia
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Crowthers RA, Arya M, Venkataraman A, Lister JJ, Cooper SE, Enich M, Stevens S, Bender E, Sanders R, Stagliano K, Jermyn RT. Impact of an osteopathic peer recovery coaching model on treatment outcomes in high-risk men entering residential treatment for substance use disorders. J Osteopath Med 2022; 122:521-529. [PMID: 35802066 DOI: 10.1515/jom-2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/12/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT The United States has witnessed a disproportionate rise in substance use disorders (SUD) and co-occurring mental health disorders, paired with housing instability, especially among racially minoritized communities. Traditional in-patient residential treatment programs for SUD have proven inconsistent in their effectiveness in preventing relapse and maintaining attrition among these patient populations. There is evidence showing that peer recovery programs led by individuals who have lived experience with SUD can increase social support and foster intrinsic motivation within participants to bolster their recovery. These peer recovery programs, when coupled with a standardized training program for peer recovery coaches, may be very efficacious at improving patient health outcomes, boosting performance on Substance Abuse and Mental Health Services Administration (SAMHSA) national outcome measures (NOMs), and helping participants build an overall better quality of life. OBJECTIVES The goal of this study is to highlight the efficacy of a peer recovery program, the Minority Aids Initiative, in improving health outcomes and associated NOMs in men with SUD and/or co-occurring mental health disorder. METHODS Participants received six months of peer recovery coaching from trained staff. Sessions were guided by the Manual for Recovery Coaching and focused on 10 different domains of recovery. Participants and coaches set long-term goals and created weekly action plans to work toward them. Standardized assessments (SAMHSA's Government Performance and Results Act [GPRA] tool, Addiction Severity Index [ASI]) were administered by recovery coaches at intake and at the 6-month time point to evaluate participant progress. Analyses of participant recovery were carried out according to SAMHSA's six NOMs and assessed the outcomes of the intervention and their significance. RESULTS A total of 115 participants enrolled in the program over a 2-year period. Among them, 53 were eligible for 6-month follow-up interviews. In total, 321 sessions were held, with an average of three sessions per participant. Participants showed marked improvement across five of the six NOMs at the end of the 6-month course and across all ASI outcomes, with the exception of three in which participants reported an absence or few symptoms at intake. CONCLUSIONS Our study shows that participants receive benefits across nearly all NOM categories when paired with recovery coaches who are well trained in medication-assisted treatment (MAT) and medications for opioid use disorder (MOUD) over a 6-month period. We see the following: a higher rate of abstinence; increased housing stability; lower health, behavioral, and social consequences; lower depression and anxiety; longer participant-recovery coach exposure time; and higher follow-up rates. We hope that our results can contribute to advancements and greater acceptance in the implementation of peer recovery coaching as well as an improvement in the lives of the communities affected by substance use.
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Affiliation(s)
- Raymond A Crowthers
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Milan Arya
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Arvind Venkataraman
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Jamey J Lister
- Rutgers University School of Social Work, Center for Prevention Science, New Brunswick, NJ, USA
| | - Sarah E Cooper
- Rutgers University School of Social Work, Center for Prevention Science, New Brunswick, NJ, USA
| | - Michael Enich
- Rutgers University School of Social Work, Center for Prevention Science, New Brunswick, NJ, USA
| | - Scott Stevens
- Maryville Addiction Treatment Center, Williamstown, NJ, USA.,Maryville Addiction Treatment Center, Pemberton, NJ, USA
| | - Emily Bender
- Maryville Addiction Treatment Center, Williamstown, NJ, USA.,Maryville Addiction Treatment Center, Pemberton, NJ, USA
| | - Roynell Sanders
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Kenneth Stagliano
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Richard T Jermyn
- Department of Rehabilitation Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
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Robinson LD, Deane FP. Substance Use Disorder and Anxiety, Depression, Eating Disorder, PTSD, and Phobia Comorbidities Among Individuals Attending Residential Substance Use Treatment Settings. J Dual Diagn 2022; 18:165-176. [PMID: 35790104 DOI: 10.1080/15504263.2022.2090648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Mental health comorbidities among individuals with a substance use disorder are common. This study provides an analysis of the prevalence, risk factors, and treatment outcomes (depression, anxiety and stress, and cravings) of individuals with comorbid depression, anxiety, posttraumatic stress disorder (PTSD), obsessive compulsive disorders (OCD), and/or eating disorders attending residential substance use treatment centers. Methods: Intake and three-month post-discharge assessments of 603 (69.3% men) people attending residential substance use treatment services were conducted using the Mental Health Screening Scale, Addiction Severity Index, Depression, Anxiety Stress Scale, and a cravings measure. Results: Anxiety disorders were common (94.5%), followed by depression (89.6%), PTSD (62.0%), OCD (33.7%), and eating disorders (21.4%). Nearly a quarter reported two comorbidities and 8.5% reported five comorbidities. Higher comorbidity levels were associated with having poorer mental health but not cravings at three-month post-discharge follow-up. Conclusions: Comorbidity is common and complex in presentations to residential substance use treatment settings. Higher levels of comorbidity are linked to poorer mental health, which remains over time.
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Affiliation(s)
- Laura D Robinson
- Centre for Health Psychology Practice and Research, University of Wollongong, Wollongong, Australia.,School of Psychology, Faculty of the Arts, Social Sciences and Humanities University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- Centre for Health Psychology Practice and Research, University of Wollongong, Wollongong, Australia.,School of Psychology, Faculty of the Arts, Social Sciences and Humanities University of Wollongong, Wollongong, Australia
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Miles J, Mericle A, Ritter G, Reif S. Association of facility characteristics and substance use disorder outcomes at discharge from residential treatment. J Subst Abuse Treat 2022; 136:108664. [PMID: 34840041 PMCID: PMC8940653 DOI: 10.1016/j.jsat.2021.108664] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/03/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Individuals with substance use disorder (SUD) may benefit from services and supports delivered in residential settings. Prior research in this area has primarily focused on individual-level factors that affect outcomes, with little focus on the relationship between facility-level characteristics and treatment outcomes. METHODS Administrative data from 2713 individuals with an index enrollment in publicly funded residential treatment in Massachusetts during 2015 were linked with facility-level survey data from 33 treatment providers. This study conducted multilevel linear and logisitc regression analysis, adjusting for resident demographic, socioeconomic, and substance use history and severity, to examine relationships between facility-level characteristics, treatment duration and completion, and housing and employment status at discharge. RESULTS Residents stayed longer when they made and enforced rules (β = 30.22, p = 0.006). Residents were less likely to complete treatment as the number of non-clinical services increased (aOR = 0.918, p = 0.029), or in facilities where residents ate together family style (aOR = 0.485, p = 0.039). Being employed at discharge was more likely when house meetings were held less than once per week (aOR = 3.37, p = 0.005) and less likely when held more than once per week (aOR = 0.385, p = 0.038). CONCLUSION Overall, increased resident governance and fewer contingencies for successful treatment participation were associated with positive treatment outcomes. Future research should examine the internal processes of residential settings, including peer-to-peer interactions, to better understand how within-residence features affect outcomes.
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Affiliation(s)
- Jennifer Miles
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA.
| | - Amy Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Grant Ritter
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
| | - Sharon Reif
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
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Whitten T, Cale J, Nathan S, Bista S, Ferry M, Williams M, Rawstorne P, Hayen A. Hospitalisation following therapeutic community drug and alcohol treatment for young people with and without a history of criminal conviction. Drug Alcohol Depend 2022; 231:109280. [PMID: 35030508 DOI: 10.1016/j.drugalcdep.2022.109280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This study examines the association between treatment in a therapeutic community for adolescents with drug and alcohol problems on hospitalisation outcomes up to 15 years later for all clients, and separately for those with and without a history of criminal conviction. METHOD A quasi-experimental design was used to examine the linked administrative health and criminal justice records for all adolescents admitted to the Program for Adolescent Life Management (PALM) from January 2001 to December 2016 (n = 3059) in Sydney, Australia. ICD-10AM codes were used to designate hospitalisation outcomes as either physical injury, mental health problems, substance use disorders, or organic illness. The treatment and comparison groups were matched on factors associated with program retention, resulting in a final sample of 1266 clients. We examined the rate of hospitalisation up to 15 years posttreatment for all clients and stratified by prior conviction status using Cox regression analyses. RESULTS The treatment group had significantly lower rates of hospitalisation for a physical injury (HR = 0.77 [95% CI = 0.61-0.98]), mental health problem (HR = 0.62 [95% CI = 0.47-0.81]), substance use disorder (HR = 0.59 [95% CI = 0.47-0.75]), and organic illness (HR = 0.71 [95% CI = 0.55-0.92]). There was a significant interaction between treatment and prior criminal conviction status on rate of hospitalisation for physical injury, suggesting that the effect of treatment on physical injury was significantly greater for clients with a prior criminal conviction. CONCLUSIONS Adolescents who engage in a therapeutic community treatment program may have a long-lasting reduction in the risk of subsequent hospitalisation. This also appears to apply to those with a history of criminal conviction.
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Affiliation(s)
- Tyson Whitten
- School of Social Sciences, University of Adelaide, Adelaide, South Australia, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
| | - Jesse Cale
- School of Criminology and Criminal Justice, Griffith University, Gold Coast, Queensland, Australia
| | - Sally Nathan
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarita Bista
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mark Ferry
- Ted Noffs Foundation, Randwick, New South Wales, Australia
| | - Megan Williams
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Patrick Rawstorne
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Whitt ZT, Sturgeon T, Rattermann MJ, Salyers M, Zapolski T, Cyders MA. Mapping recovery: A qualitative node map approach to understanding factors proximal to relapse among adolescents in a recovery high school. J Subst Abuse Treat 2022; 138:108750. [DOI: 10.1016/j.jsat.2022.108750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/14/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
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30
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Tse N, Tse S, Wong P, Adams P. Collective Motivational Interviewing for Substance Use Problems: Concept and Implications. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00736-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hogue A, Schumm JA, MacLean A, Bobek M. Couple and family therapy for substance use disorders: Evidence-based update 2010-2019. J Marital Fam Ther 2022; 48:178-203. [PMID: 34435387 DOI: 10.1111/jmft.12546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/24/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
This article updates the evidence-based on couple and family therapy interventions for substance use disorders (SUD) since publication of the previous JMFT reviews in 2012. It first summarizes previous reviews along with findings from more recent reviews and meta-analytic studies. It then presents study design and methods criteria used to select 13 studies of couple and family therapy for level of support evaluation. Cumulative level of support designations are then determined for identified treatment approaches. Findings indicate that systemic family therapy is well-established as a standalone treatment, and behavioral family therapy and behavioral couple therapy are probably efficacious as standalone treatments and well-established as part of a multicomponent treatment. The article then suggests practice guidelines with regard to treatment modality considerations and implementation challenges. It concludes with future directions for delivering couple and family interventions in routine systems of care for SUD.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, Suite, New York, USA
| | - Jeremiah A Schumm
- School of Professional Psychology, Wright State University and OneFifteen, Inc./Samaritan Behavioral Health, Inc., Dayton, Ohio, USA
| | | | - Molly Bobek
- Partnership to End Addiction, Suite, New York, USA
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Mannes ZL, Shmulewitz D, Livne O, Stohl M, Hasin DS. Correlates of mild, moderate, and severe Alcohol Use Disorder among adults with problem substance use: Validity implications for DSM-5. Alcohol Clin Exp Res 2021; 45:2118-2129. [PMID: 34581461 DOI: 10.1111/acer.14701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The DSM-5 definition of alcohol use disorder (AUD) has been well validated, but information is lacking on the extent to which alcohol use, comorbidity, and impairment are associated with the 3 DSM-5-defined AUD severity levels: mild, moderate, and severe. This study examined clinical and functional characteristics as predictors (validators) of these severity levels. METHODS Participants aged ≥18 years reporting current problem substance use (N = 588) were recruited between 2016 and 2019 and assessed for DSM-5 AUD and a set of potential validators: indicators of alcohol use severity (i.e., craving, binge drinking frequency, problematic use, and harmful drinking), psychiatric disorders, and functional impairment. Multinomial logistic regression models examined the association between the predictors and the 3 AUD severity levels (mild, moderate, and severe) vs the reference group, no AUD, controlling for sociodemographic characteristics and other substance use. RESULTS All alcohol use validators were associated with a greater likelihood of all 3 AUD severity levels compared with the no-AUD group. However, psychiatric disorders were associated only with severe AUD and participants with major depression (aOR = 2.44), posttraumatic stress disorder (aOR = 1.65), borderline personality disorder (aOR = 1.99), and antisocial personality disorder (aOR = 1.78) had a greater likelihood of severe AUD than the no-AUD group. Functioning validators were also associated only with severe AUD and participants with social (aOR = 1.87), physical (aOR = 1.62), or mental (aOR = 1.84) impairment had a greater likelihood of severe AUD than the no-AUD group. Many alcohol-related, psychiatric, and functioning validators were associated with greater odds of severe AUD than mild or moderate AUD. CONCLUSION This study supports the criterion validity of the DSM-5 tri-categorical measure of AUD. Specifically, results fully supported the validity of severe AUD by its associations with all predictors, whereas the validity of mild and moderate AUD was supported only by alcohol use predictor variables. Findings suggest the value of using severity-specific interventions utilizing the DSM-5 AUD.
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Affiliation(s)
- Zachary L Mannes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, New York, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA
| | - Malki Stohl
- New York State Psychiatric Institute, New York, New York, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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Stahler GJ, Mennis J, Baron DA. Racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) and their effects on residential drug treatment outcomes in the US. Drug Alcohol Depend 2021; 226:108849. [PMID: 34198132 DOI: 10.1016/j.drugalcdep.2021.108849] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study examines racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) in residential treatment and the influence of race/ethnicity on the association between MOUD use and treatment retention and completion. METHODS Data were extracted from SAMHSA's 2015-2017 Treatment Episode Dataset-Discharge (TEDS-D) datasets for adult opioid admissions/discharges to short-term (ST) (30 days or less) (N = 83,032) or long-term (LT) (> 30 days) residential treatment settings (N=61,626). Logistic regression estimated the likelihood of MOUD use among racial/ethnic groups and the moderation of race/ethnicity on the probability of treatment completion and retention, controlling for background factors. RESULTS After adjusting for covariates, compared to Whites, MOUD use was less likely for Blacks in ST (OR = 0.728) and LT settings (OR = 0.725) and slightly less likely for Hispanics in ST settings (OR = 0.859) but slightly more likely for Hispanics in LT settings (OR = 1.107). In ST settings, compared to Whites, the positive effect of MOUD on retention was enhanced for Blacks (OR = 1.191) and Hispanics (OR = 1.234), and the positive effect on treatment completion was enhanced for Hispanics (OR = 1.144). In LT settings, the negative association between MOUD and treatment completion was enhanced for Hispanics (OR = 0.776). CONCLUSIONS Access to medications for opioid use disorder in short term residential treatment is particularly beneficial for Blacks and Hispanics, though adjusted models indicate they are less likely to receive it compared to Whites. Results are mixed for long-term residential treatment. Residential addiction treatment may represent an important setting for mitigating low rates of medication initiation and early discontinuation for minority patients.
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Marceau EM, Holmes G, Cutts J, Mullaney L, Meuldijk D, Townsend ML, Grenyer BFS. Now and then: a ten-year comparison of young people in residential substance use disorder treatment receiving group dialectical behaviour therapy. BMC Psychiatry 2021; 21:362. [PMID: 34284750 PMCID: PMC8293584 DOI: 10.1186/s12888-021-03372-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/08/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Reducing substance use in youth is a global health priority. We compared two cohorts from the same 12-week residential substance use disorder (SUD) facility over a 10 year period: Cohort A (2008-2009) and Cohort B (2018-2020). The essential components of the program remained the same with the primary treatment being dialectical behaviour therapy (DBT) plus residential milieu. METHODS Young people in the current Cohort B (N = 100) versus historical Cohort A (N = 102) had a similar ratio of males (74 vs. 70%) but were slightly older (mean 20.6 vs. 19.5 years). Linear mixed models were used to model outcome measures (global psychiatric symptoms, substance use severity, and quality of life) longitudinally up to 12 months later. RESULTS Baseline to end-of-treatment comparisons showed that the current Cohort B had overall higher levels of global psychiatric symptoms (d = 0.70), but both groups reduced psychiatric symptoms (Cohort A: d = 1.05; Cohort B: d = 0.61), and had comparable increases in confidence to resist substance use (d = 0.95). Longitudinal data from the current Cohort B showed significant decreases in substance use severity from baseline to 6-month follow-up (d = 1.83), which were sustained at 12-month follow-up (d = 0.94), and increases in quality of life from baseline to end-of-treatment (d = 0.83). CONCLUSIONS We demonstrate how DBT plus milieu residential care for young people continues to show positive effects in a 10-year comparison. However, youth seeking treatment today compared to 10 years ago evidenced higher acuity of psychiatric symptoms reinforcing the importance of continuous improvement of psychological treatments. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: trial ID ACTRN12618000866202 , retrospectively registered on 22/05/2018, .
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Affiliation(s)
- Ely M. Marceau
- grid.1007.60000 0004 0486 528XSchool of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
| | - Gabriella Holmes
- grid.474015.30000 0004 0644 0816Mission Australia: Triple Care Farm, 188 Knights Hill Rd, NSW 2577 Knights Hill, Australia
| | - Jane Cutts
- grid.1007.60000 0004 0486 528XSchool of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia ,grid.474015.30000 0004 0644 0816Mission Australia: Triple Care Farm, 188 Knights Hill Rd, NSW 2577 Knights Hill, Australia
| | - Lauren Mullaney
- grid.474015.30000 0004 0644 0816Mission Australia: Triple Care Farm, 188 Knights Hill Rd, NSW 2577 Knights Hill, Australia
| | - Denise Meuldijk
- grid.1007.60000 0004 0486 528XSchool of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia ,grid.1005.40000 0004 4902 0432Black Dog Institute, Faculty of Medicine, University of New South Wales, NSW 2052 Sydney, Australia
| | - Michelle L. Townsend
- grid.1007.60000 0004 0486 528XSchool of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
| | - Brin F. S. Grenyer
- grid.1007.60000 0004 0486 528XSchool of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
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Miles J, Bunn T, Kizewski A, Jennings T, Waters T, Johnson D, Sheridan D, Fletcher E. Assessing Technical Assistance Needs among Recovery Residence Operators in the United States. J Psychoactive Drugs 2021; 54:188-195. [PMID: 34269163 DOI: 10.1080/02791072.2021.1941442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Recovery support services such as recovery housing assist individuals with increasing their access to social support, employment services, and systems of care. Lack of evidence-based practices and calls for increased oversight of these settings suggests a growing need for technical assistance and training for recovery residence owners and staff, yet little is known about their areas of greatest need for technical assistance. We developed and administered a survey to assess the technical assistance needs of recovery housing operators in the United States using a convenience sample of individuals who own or operate a recovery residence (N = 376). A total of 77 owners/operators completed the survey (20% response rate), representing urban, suburban, and rural communities. Differences were observed between number of owned residences: owners/operators of a single residence were interested in technical assistance on house-specific policies and linkage to established systems of care, whereas owners/operators of multiple residences were interested in technical assistance on building financial sustainability and incorporation of best practices into their recovery residences. As an increasing number of states move to implement voluntary certification or licensing for recovery residences, targeted training and technical assistance to owners/operators will facilitate the successful adoption of recovery residence best practices and quality standards.
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Affiliation(s)
- Jennifer Miles
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Terry Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Amber Kizewski
- Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Tyler Jennings
- Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Teresa Waters
- Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY, USA
| | | | - Dave Sheridan
- National Alliance for Recovery Residences, St. Paul, MN, USA
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Clair K, Ijadi-Maghsoodi R, Nazinyan M, Gabrielian S, Kalofonos I. Veteran Perspectives on Adaptations to a VA Residential Rehabilitation Program for Substance Use Disorders During the Novel Coronavirus Pandemic. Community Ment Health J 2021; 57:801-807. [PMID: 33675451 PMCID: PMC7970813 DOI: 10.1007/s10597-021-00810-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/23/2021] [Indexed: 12/03/2022]
Abstract
Individuals attending residential rehabilitation programs for substance misuse are particularly vulnerable to treatment disruptions spurred by the novel coronavirus disease 2019 (COVID-19) pandemic. We describe adaptations to services within a large residential rehabilitation program for under-resourced veterans, report veterans' experiences with these changes, and outline successes and challenges encountered throughout adjustment to the pandemic. Data collected from two focus groups with nine veterans engaged in this program during the pandemic highlight experiences of inconsistent communication about residential policies, interruptions to medical and addiction services, and feelings of confinement and social isolation. Overall, these findings suggest the need for health systems to support clients in taking an active role in communications, provide additional technical and social support in transitioning to virtual health services, and offer alternative means for clients to maintain social connection during a pandemic. Understanding clients' perspectives can inform strategies to promote continuity of care and enhanced care experiences.
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Affiliation(s)
- Kimberly Clair
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg 210A, Los Angeles, CA, 90073, USA.
| | - Roya Ijadi-Maghsoodi
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg 210A, Los Angeles, CA, 90073, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.,Center of Excellence for Veteran Resilience and Recovery, UCLA, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA.,UCLA Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Mariam Nazinyan
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.,Center of Excellence for Veteran Resilience and Recovery, UCLA, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA
| | - Sonya Gabrielian
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg 210A, Los Angeles, CA, 90073, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.,Center of Excellence for Veteran Resilience and Recovery, UCLA, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA
| | - Ippolytos Kalofonos
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg 210A, Los Angeles, CA, 90073, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.,Center of Excellence for Veteran Resilience and Recovery, UCLA, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA, 90073, USA.,UCLA Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.,UCLA International Institute, 1248 Bunche Hall, Los Angeles, CA, 90095, USA
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Macken S, Nathan S, Jersky M, Boydell KM, Gibson A. Body Mapping in a Drug and Alcohol Treatment Program: Eliciting New Identity and Experience. Int J Environ Res Public Health 2021; 18:ijerph18094942. [PMID: 34066465 PMCID: PMC8125476 DOI: 10.3390/ijerph18094942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/22/2022]
Abstract
Arts-based approaches have not been widely used in the drug and alcohol treatment sector. In this study, we examined the utility of the arts-based method of Body Mapping in an Australian residential treatment centre. Two workshops were held to explore young people’s strengths and support networks in order to improve understandings of young people’s lives, identities and experiences of treatment. Semi-structured follow-up interviews were conducted and triangulated with observational notes and staff interviews. We identified four major themes: engaging through art; removing the mask; revealing strengths; and a sense of achievement. Overall, this study highlighted the value of Body Mapping as an approach to engage with young people, providing rich in-depth data about their lived experiences, including in the alcohol and other drug (AOD) treatment context.
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Affiliation(s)
- Sophia Macken
- School of Population Health, UNSW Sydney, Sydney 2052, Australia;
| | - Sally Nathan
- School of Population Health, UNSW Sydney, Sydney 2052, Australia;
- Correspondence:
| | | | | | - Alexandra Gibson
- School of Health, Victoria University of Wellington-Te Herenga Waka, 6012 Wellington, New Zealand;
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Chikwava F, Cordier R, Ferrante A, O'Donnell M, Speyer R, Parsons L. Research using population-based administration data integrated with longitudinal data in child protection settings: A systematic review. PLoS One 2021; 16:e0249088. [PMID: 33760881 DOI: 10.1371/journal.pone.0249088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/11/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Over the past decade there has been a marked growth in the use of linked population administrative data for child protection research. This is the first systematic review of studies to report on research design and statistical methods used where population-based administrative data is integrated with longitudinal data in child protection settings. Methods The systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. The electronic databases Medline (Ovid), PsycINFO, Embase, ERIC, and CINAHL were systematically searched in November 2019 to identify all the relevant studies. The protocol for this review was registered and published with Open Science Framework (Registration DOI: 10.17605/OSF.IO/96PX8) Results The review identified 30 studies reporting on child maltreatment, mental health, drug and alcohol abuse and education. The quality of almost all studies was strong, however the studies rated poorly on the reporting of data linkage methods. The statistical analysis methods described failed to take into account mediating factors which may have an indirect effect on the outcomes of interest and there was lack of utilisation of multi-level analysis. Conclusion We recommend reporting of data linkage processes through following recommended and standardised data linkage processes, which can be achieved through greater co-ordination among data providers and researchers.
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Marsh TN, Eshakakogan C, Eibl JK, Spence M, Morin KA, Gauthier GJ, Marsh DC. A study protocol for a quasi-experimental community trial evaluating the integration of indigenous healing practices and a harm reduction approach with principles of seeking safety in an indigenous residential treatment program in Northern Ontario. Harm Reduct J 2021; 18:35. [PMID: 33731138 PMCID: PMC7967948 DOI: 10.1186/s12954-021-00483-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Indigenous communities in Canada face significant challenges with intergenerational trauma, which manifests in substance use disorders. There is consensus that connecting treatment approaches to culture, land, community, and spiritual practices is a pathway to healing trauma and substance use disorders for Indigenous peoples. Indigenous residential addiction treatment programs have been established as the primary intervention to provide healing for Indigenous peoples with substance use disorders and intergenerational trauma. However, there is limited evidence demonstrating the effectiveness of these programs. In collaboration with the Benbowopka Treatment Centre, this paper describes a study protocol which aims to evaluate the effectiveness of blending Indigenous Healing Practices and Seeking Safety for the treatment of Indigenous patients with intergenerational trauma and substance use disorders. Methods We will conduct a pre/post Quasi Experimental Community trial, to compare historical treatment outcomes for patients following the implementation of Indigenous Healing and Seeking Safety. We will conduct quantitative and qualitative analyses to understand the differences before and after the intervention is implemented. The pre- Indigenous Healing and Seeking Safety intervention study window will span from 2013 to 2016; n = 343, and the post-Indigenous Healing and Seeking Safety intervention study window from 2018 to 2020; n > 300. All participants will be enrolled in the Benbowopka residential treatment for the first time during the study periods. All data will be anonymized at the time of data entry. Propensity matching will be undertaken for patient characteristics, including sex/gender, age, and substance use type. Results and conclusions The study findings could be used to inform intergenerational trauma and substance use disorders residential treatment programming for Indigenous communities across Canada. Our work will contribute to the field of community-based intergenerational trauma and substance use disorders programming by addressing objectives that consider: (a) the patient perspective, (b) the program perspective, and (c) the community perspective. The study findings may validate an innovative approach for evaluating the effectiveness of residential addiction treatment and particularly the effective and appropriate care for Indigenous patients with intergenerational trauma and substance use disorders.
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Affiliation(s)
- T N Marsh
- Northern Ontario School of Medicine, Sudbury, Canada.
| | | | - J K Eibl
- Northern Ontario School of Medicine, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Canada.,ICES North, Sudbury, Canada
| | - M Spence
- Northern Ontario School of Medicine, Sudbury, Canada
| | - K A Morin
- Northern Ontario School of Medicine, Sudbury, Canada
| | - G J Gauthier
- Northern Ontario School of Medicine, Sudbury, Canada
| | - D C Marsh
- Northern Ontario School of Medicine, Sudbury, Canada.,Health Sciences North Research Institute, Sudbury, Canada.,ICES North, Sudbury, Canada.,Canadian Addiction Treatment Centres, Markham, Canada
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40
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Andersson HW, Lilleeng SE, Ose SO. Comparison of social and sociodemographic characteristics and treatment goals of persons with alcohol versus drug use disorders: Result from a national census of inpatients in specialized treatment for substance use. Addict Behav Rep 2021; 13:100340. [PMID: 33614886 PMCID: PMC7878974 DOI: 10.1016/j.abrep.2021.100340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 01/19/2023] Open
Abstract
A national census of patients in residential substance use treatment. We compared inpatients with primary alcohol use disorders vs. drug use disorders. Patients with drug use disorders were more likely sociodemographic disadvantaged. Patients with drug use disorders more likely had poor friend relationships. Treatment goal differences disappeared when adjusted for sociodemographic variables.
Introduction We examined differences in social and sociodemographic characteristics and treatment goals between people with primary alcohol use disorder (AUD) versus those with a primary drug use disorder receiving inpatient treatment for a substance use disorder (SUD). Methods A national census utilizing a cross sectional design included 56 of 60 specialized inpatient SUD treatment clinics in Norway and all patients receiving treatment on a specific date (responserate = 70%). Data on substance use, social and sociodemographic characteristics, and patient-reported treatment goals were collected. Patients were classified as having primary AUD or a drug use disorder based on the main SUD diagnosis relevant to the treatment episode. Results The analytic sample included 1093 patients. Patients with primary AUD (n = 362) were more often older, had a higher educational level and income from work, and lived in permanent housing compared with patients with a drug use disorder (n = 731). Patients with AUD were more likely to have good relationships with friends. The higher frequency of reported reduced substance use (versus quitting substance use) as the treatment goal among AUD patients disappeared when controlled for sociodemographic factors. Conclusions Knowledge about the different characteristics of inpatients with AUD versus a drug use disorder is relevant when conducting research involving the SUD treatment population and for facilitating treatment. The lower frequency of perceived support from friends among patients with a drug use disorder suggests a need for targeted efforts in (re)building supportive social relationships for inpatients being treated for SUD.
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Affiliation(s)
- Helle Wessel Andersson
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, PB 3250 Sluppen, 7006 Trondheim, Norway
| | - Solfrid E Lilleeng
- The Norwegian Directorate of Health, Department of Analysis and Performance Assessment, Holtermanns vei 70, Trondheim 7031, Norway
| | - Solveig Osborg Ose
- SINTEF Technology and Society, Department of Health, Klæbuveien 153, Trondheim 7049, Norway
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Ware OD, Manuel JI, Huhn AS. Adults With Opioid and Methamphetamine Co-use Have Lower Odds of Completing Short-Term Residential Treatment Than Other Opioid Co-use Groups: A Retrospective Health Services Study. Front Psychiatry 2021; 12:784229. [PMID: 34955930 PMCID: PMC8692265 DOI: 10.3389/fpsyt.2021.784229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: There is an increase in persons entering substance use treatment who co-use opioids and methamphetamines in recent years. Co-using these substances may negatively impact treatment retention in the residential setting. We explored predictors of adults completing short-term residential treatment among persons with primary opioid use disorder (OUD) who co-use either alcohol, benzodiazepines, cocaine, or methamphetamines. Methods: This study used the 2019 de-identified, publicly available Treatment Episode Dataset-Discharges. The sample included adults discharged from short-term residential treatment with primary OUD who co-used either alcohol, benzodiazepines, cocaine, or methamphetamines. The final sample size included 24,120 treatment episodes. Univariate statistics were used to describe the sample. Two logistic regression models were used to predict completing treatment. The first logistic regression model included the co-use groups as predictors and the second model added other demographic and treatment-relevant covariates. Results: A slight majority (51.4%) of the sample prematurely discharged from treatment. Compared to the other three co-use groups, the opioid and methamphetamine co-use group had the highest proportion of individuals who were women (45.0%), unemployed (62.5%), current injection drug use (76.0%), living in the Midwest (35.9%), living in the south (33.5%), and living in the west (15.5%). The opioid and methamphetamine co-use group also had the highest proportion of individuals not receiving medications for OUD (84.9%), not having a prior treatment episode (28.7%), and not completing treatment (57.4%). In the final logistic regression model, which included covariates, the opioid and alcohol (OR = 1.18, 95% CI = 1.080-1.287, p < 0.001), opioid and benzodiazepine (OR = 1.33, 95% CI = 1.213-1.455, p < 0.001), and opioid and cocaine (OR = 1.16, 95% CI = 1.075-1.240, p < 0.001) co-use groups had higher odds of completing treatment than the opioid and methamphetamine co-use group. Conclusions: Opioid and methamphetamine co-use may complicate short-term residential treatment retention. Future work should identify effective strategies to retain persons who co-use opioids and methamphetamines in treatment.
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Affiliation(s)
- Orrin D Ware
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jennifer I Manuel
- Silver School of Social Work, New York University, New York, NY, United States
| | - Andrew S Huhn
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Oesterle TS, Kolla B, Risma CJ, Breitinger SA, Rakocevic DB, Loukianova LL, Hall-Flavin DK, Gentry MT, Rummans TA, Chauhan M, Gold MS. Substance Use Disorders and Telehealth in the COVID-19 Pandemic Era: A New Outlook. Mayo Clin Proc 2020; 95:2709-2718. [PMID: 33276843 PMCID: PMC7577694 DOI: 10.1016/j.mayocp.2020.10.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/19/2020] [Indexed: 02/05/2023]
Abstract
During the current coronavirus disease 2019 epidemic, many outpatient chemical dependency treatment programs and clinics are decreasing their number of in-person patient contacts. This has widened an already large gap between patients with substance use disorders (SUDs) who need treatment and those who have actually received treatment. For a disorder where group therapy has been the mainstay treatment option for decades, social distancing, shelter in place, and treatment discontinuation have created an urgent need for alternative approaches to addiction treatment. In an attempt to continue some care for patients in need, many medical institutions have transitioned to a virtual environment to promote safe social distancing. Although there is ample evidence to support telemedical interventions, these can be difficult to implement, especially in the SUD population. This article reviews current literature for the use of telehealth interventions in the treatment of SUDs and offers recommendations on safe and effective implementation strategies based on the current literature.
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Affiliation(s)
- Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | | | | | | | | | | | | | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Mohit Chauhan
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
| | - Mark S Gold
- Department of Psychiatry, National Council, Institute for Public Health, Washington University School of Medicine Washington University in St Louis, St Louis, MO
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Barocas JA, Blackstone E, Bouton TC, Kimmel SD, Caputo A, Porter SJ, Walley AY. Prevalence of Covid-19 Infection and Subsequent Cohorting in a Residential Substance Use Treatment Program in Boston, MA. J Addict Med 2020; 14:e261-3. [PMID: 32530889 DOI: 10.1097/ADM.0000000000000700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The global pandemic of coronavirus disease 2019 (Covid-19) may disproportionately affect persons in congregate settings, including those in residential substance use treatment facilities. To limit the spread of SARS-CoV-2 through congregate settings, universal testing may be necessary. We aimed to determine the point prevalence of SARS-CoV-2 in a residential treatment program setting and to understand the unique challenges of Covid-19 transmission in this setting. METHODS We performed a case series of SARS-CoV-2 rT-PCR testing via nasopharyngeal in a residential substance use treatment program for women in Boston. Staff and residents of the treatment program were tested for SARS-CoV-2. The primary outcome was SARS-CoV-2 test result. RESULTS A total of 31 residents and staff were tested. Twenty-seven percent (6/22) of the residents and 44% (4/9) of staff tested positive for SARS-CoV-2. All of the SARS-CoV-2 positive residents resided in the same residential unit. Two positive cases resided together with 2 negative cases in a 4-person room. Two other positive cases resided together in a 2-person room. One positive case resided with 2 negative cases in a 3-person room. One positive case resided with a negative case in a 2-person room. Based on test results, residents were cohorted by infection status and continued to participate in addiction treatment on-site. CONCLUSIONS SARS-CoV-2 infection was common among staff and residents within a residential substance use treatment program for women in Boston. Universal SARS-CoV-2 testing in residential substance use programs can be instituted to reduce the risk of further transmission and continue addiction treatment programming when accompanied by adequate space, supplies, and staffing.
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Arria AM, Bugbee BA, Mader J, Smith JM, Winters KC. Postdischarge Outcomes of Adolescents Attending a Long-term Addiction Treatment Program. Addictive Disorders & Their Treatment 2021; 20:117-126. [DOI: 10.1097/adt.0000000000000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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MacLeay E, Fry M, Roche MA, Montilla T. Care planning and nonpharmacological interventions in a metropolitan inpatient dual diagnosis service: A retrospective exploratory study. Int J Ment Health Nurs 2020; 29:856-867. [PMID: 32243035 DOI: 10.1111/inm.12719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/22/2020] [Accepted: 02/23/2020] [Indexed: 11/30/2022]
Abstract
In Australia, the terms dual diagnosis and comorbidity are commonly used, often interchangeably, to describe the experience of consumers with both mental health difficulties and difficulties with alcohol and other drug use. Consumers with comorbidity often have complex needs that require comprehensive assessment, multidisciplinary team support, and trauma-focused management. More information about the demographics of consumers admitted with comorbidity, and the documented assessed needs, care, and interventions provided, would provide the foundations for working towards improved quality and continuity of care. Therefore, the aim of this study was to explore the documentation of inpatient assessment, care, and interventions provided to people with comorbidity. The research design was a retrospective exploratory study, and data collection involved a 12-month healthcare record audit. Forty-one records were screened, and 36 consumer healthcare records were identified as eligible for inclusion in the study. Most consumers (n = 34, 94%) were admitted on an involuntary basis, and 8 (22.2%) were female. Consumers had a median length of stay of almost six months. In most healthcare records, there was no documented evidence of care planning involvement by consumers or the multidisciplinary team. There was great variance in the delivery of nonpharmacological interventions. Most consumers did not receive trauma-focused assessment or intervention, and assessment tools were often incomplete with outcome measures poorly documented. This study has demonstrated significant gaps in consumer and multidisciplinary engagement with care planning and goal setting. There was poor documentation of comprehensive assessment and nonpharmacological interventions.
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Affiliation(s)
- Euan MacLeay
- Mental Health Drug and Alcohol, Northern Sydney Local Health Service, Sydney, New South Wales, Australia.,UTS: School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Macquarie Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Margaret Fry
- UTS: School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,NSLHD Research and Practice Development, Nursing and Midwifery Directorate, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michael Anthony Roche
- Mental Health Drug and Alcohol, Northern Sydney Local Health Service, Sydney, New South Wales, Australia.,UTS: School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Tim Montilla
- Mental Health Drug and Alcohol, Northern Sydney Local Health Service, Sydney, New South Wales, Australia.,UTS: School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Stahler GJ, Mennis J. The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US. Drug Alcohol Depend 2020; 212:108067. [PMID: 32445926 DOI: 10.1016/j.drugalcdep.2020.108067] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND This study examines whether MOUD increases treatment completion and retention in both short-term (ST) and long-term (LT) residential programs using a national dataset. METHODS Data were extracted from the 2015-2017 TEDS-D (Treatment Episode Dataset-Discharge) datasets for opioid using adults in ST (n = 87,296) and LT (n = 66,623) residential treatment. Primary outcome variables were treatment completion and retention (ST: length of stay >10 days; LT: >90 days). Logistic regression estimated the effects of MOUD on the probability of treatment completion and retention separately for ST and LT residential treatment, controlling for individual background characteristics. RESULTS Only 18% of clients in residential treatment programs had MOUD in their treatment plans. For ST residential treatment, MOUD was associated with a 40% increased likelihood of treatment completion (OR = 1.404) and 34% increased retention (OR = 1.337). For LT residential treatment, MOUD was associated with a 26% reduced likelihood of treatment completion (OR = 0.743) and no significant increase in retention. Post hoc analysis suggests insurance coverage may be influencing outcomes. CONCLUSIONS Despite MOUD being a standard of care for OUD, MOUD is particularly under-utilized in residential treatment. Further research should focus on how best to integrate MOUD within short-term residential treatment and to explore the potential viability of MOUD in long-term residential programs. Given the risk of overdose following residential treatment, for at least short-term residential programs, this setting may be advantageous for integrating psychosocial treatments with early MOUD engagement in a structured therapeutic environment as part of a long-term continuum of care recovery program.
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Affiliation(s)
- Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States.
| | - Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States.
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Lo TW, Yeung JWK, Tam CHL. Substance Abuse and Public Health: A Multilevel Perspective and Multiple Responses. Int J Environ Res Public Health 2020; 17:ijerph17072610. [PMID: 32290248 PMCID: PMC7177685 DOI: 10.3390/ijerph17072610] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/02/2023]
Abstract
Substance abuse has been a thorny public health concern throughout human history. Manifestly, prevention and treatment are the two main strategies commonly adopted to tackle the problem of substance abuse. They are in fact cross-disciplinary, and they relate to the various domains of heredity, biology, psychology, cognitive science, family, social development and cultural structures. This special issue, "Substance Abuse, Environment and Public Health," has published empirical studies from different regions and countries globally to enhance the international exchange of latest views and findings on the etiology, processes and influences of substance abuse across different domains, through which a multilevel perspective is considered more helpful for analyzing its complex nature, courses and consequences. This in turn suggests the possible need to employ multiple responses dynamically and integratively in the prevention and treatment of substance abuse.
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48
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Affiliation(s)
- Teresa May
- Harris County Community Supervision and Corrections Department, Houston, USA
| | - Travis C. Pratt
- Harris County Community Supervision and Corrections Department, University of Cincinnati Corrections Institute, Cincinnati, USA
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Morgan JR, Wang J, Barocas JA, Jaeger JL, Durham NN, Babakhanlou-Chase H, Bharel M, Walley AY, Linas BP. Opioid overdose and inpatient care for substance use disorder care in Massachusetts. J Subst Abuse Treat 2020; 112:42-48. [PMID: 32199545 DOI: 10.1016/j.jsat.2020.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Inpatient treatment for substance use disorders is a collection of strategies ranging from short term detoxification to longer term residential treatment. How those with opioid use disorder (OUD) navigate this inpatient treatment system after an encounter for detoxification and subsequent risk of opioid-related overdose is not well understood. METHODS We used a comprehensive Massachusetts database to characterize the movement of people with OUD through inpatient care from 2013 to 2015, identifying admissions to inpatient detoxification, subsequent inpatient care, and opioid overdose while navigating treatment. We measured the person-years accumulated during each transition period to calculate rates of opioid-related overdose, and investigated how overdose differed in select populations. RESULTS Sixty-one percent of inpatient detoxification admissions resulted in a subsequent inpatient detoxification admission without progressing to further inpatient care. Overall, there were 287 fatal and 7337 non-fatal overdoses. Persons exiting treatment after detoxification had the greatest risk of overdose (17.3 per 100 person-years) compared to those who exited after subsequent inpatient care (ranging from 5.9 to 6.6 overdoses per 100 person-years). Non-Hispanic whites were most at risk for opioid related overdose with 16 overdoses per 100 person-years and non-Hispanic blacks had the lowest risk with 5 overdoses per 100 person-years. CONCLUSIONS The majority of inpatient detoxification admissions do not progress to further inpatient care. Recurrent inpatient detoxification admission is common, likely signifying relapse. Rather than functioning as the first step to inpatient care, inpatient detoxification might be more effective as a venue for implementing strategies to expand addiction services or treatment such as medications for opioid use disorder.
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Affiliation(s)
- Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Jianing Wang
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Joshua A Barocas
- Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA, USA; Brigham and Women's Hospital, Division of Infectious Diseases, Boston, MA, USA
| | | | | | | | - Monica Bharel
- Massachusettes Department of Public Health, Boston, MA, USA
| | - Alexander Y Walley
- Massachusettes Department of Public Health, Boston, MA, USA; Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Benjamin P Linas
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Morgan N, Daniels W, Subramaney U. An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification. Subst Abuse Rehabil 2020; 11:1-8. [PMID: 32021548 PMCID: PMC6955608 DOI: 10.2147/sar.s228224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/22/2019] [Indexed: 11/23/2022] Open
Abstract
Background Given that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use. Methods 300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6-8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints. Results Of the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased. Conclusion After detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.
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Affiliation(s)
- Nirvana Morgan
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - William Daniels
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ugasvaree Subramaney
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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