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Robles EH, Castro Y, Najera S, Cardoso J, Gonzales R, Mallonee J, Segovia J, Hinojosa-Salazar L, De Vargas C, Field C. Men of Mexican ethnicity, alcohol use, and help-seeking: "I can quit on my own.". J Subst Use Addict Treat 2024:209359. [PMID: 38677598 DOI: 10.1016/j.josat.2024.209359] [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: 08/21/2022] [Revised: 03/25/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Hispanics report higher rates of problematic alcohol use compared to non-Hispanic Whites while also reporting lower rates of alcohol treatment utilization compared to non-Hispanics. The study employs Anderson's Behavioral Model of Healthcare Utilization Model to guide the exploration of alcohol use, help-seeking and healthcare utilization. METHODS The present qualitative study explored help-seeking and alcohol treatment utilization for Hispanic men of Mexican ethnicity. A total of 27 participants (Mage = 35.7, SD = 10.82) completed a semi-structured interview that explored the treatment experiences and underlying psychological mechanisms that shaped their help-seeking. RESULTS Through a thematic content analysis, the following themes emerged: 1) perceiving need with subthemes of familismo, role as protector and provider, and positive face; 2) predisposing beliefs on help-seeking; and 3) treatment experiences and elements of patient satisfaction with subthemes of monetized treatment, respect, and perceiving professional stigma. CONCLUSIONS The findings in this article may assist in improving strategies for increasing alcohol treatment utilization among men of Mexican ethnicity. By exploring beliefs, values, and experiences health researchers can develop culturally informed intervention strategies.
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Affiliation(s)
- Eden Hernandez Robles
- Worden School of Social Service, Our Lady of the Lake University, United States of America.
| | - Yessenia Castro
- Steve Hicks School of Social Work, The University of Texas at Austin, United States of America
| | - Sarah Najera
- Department of Psychology, The University of Texas at El Paso, United States of America
| | - Juliana Cardoso
- Department of Psychology, Hastings College, United States of America
| | - Rubi Gonzales
- St. Louis School of Medicine, Washington University, United States of America
| | - Jason Mallonee
- Department of Social Work, The University of Texas at El Paso, United States of America
| | - Javier Segovia
- Worden School of Social Service, Our Lady of the Lake University, United States of America
| | | | - Cecilia De Vargas
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, United States of America
| | - Craig Field
- Department of Psychology, The University of Texas at El Paso, United States of America
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Silva MA, Añez LM, Carroll KM, Jaramillo Y, Kiluk BD, Frankforter T, Ball SA, Gordon MA, Paris M. Computer-based training for cognitive behavioral therapy for Spanish-speaking substance users: adaptation and satisfaction. J Ethn Subst Abuse 2024; 23:251-271. [PMID: 35714996 PMCID: PMC10350903 DOI: 10.1080/15332640.2022.2086194] [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] [Indexed: 10/18/2022]
Abstract
There are few available culturally and linguistically adapted behavioral health interventions for substance use among Spanish-speaking adults. The authors describe the cultural adaptation of an innovative computer-based training for cognitive behavioral therapy program (CBT4CBT). Based in cognitive-behavioral skills training, CBT4CBT utilizes a telenovela to teach monolingual Spanish-speaking adults who have migrated to the United States to recognize triggers; avoid these situations; and cope more effectively with the consequences of substance use. Participants endorsed high levels of satisfaction with the program content and found the material to be easy to understand and relevant to their life experiences.
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Affiliation(s)
- Michelle A Silva
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Luis M Añez
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Yudilyn Jaramillo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Brian D Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Tami Frankforter
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Samuel A Ball
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Melissa A Gordon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Manuel Paris
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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Shearer RD, Segel JE, Howell BA, Jones AA, Khatri UG, da Silva DT, Vest N, Winkelman TN. Racial and Ethnic Differences in Heroin, Methamphetamine, and Cocaine Use, Treatment, and Mortality Trends in 3 National Data Sources-United States, 2010-2019. Med Care 2024; 62:151-160. [PMID: 38180005 PMCID: PMC10922552 DOI: 10.1097/mlr.0000000000001969] [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] [Indexed: 01/06/2024]
Abstract
BACKGROUND As overdose deaths continue to rise, public health officials need comprehensive surveillance data to design effective prevention, harm reduction, and treatment strategies. Disparities across race and ethnicity groups, as well as trends in substance use, treatment, or overdose deaths, have been examined individually, but reports rarely compare findings across multiple substances or data sources. OBJECTIVE To provide a broad assessment of the overdose crisis, we describe trends in substance use, treatment, and overdose mortality across racial and ethnic groups for multiple substances. RESEARCH DESIGN We conducted a longitudinal, cross-sectional analysis comparing trends. SUBJECTS We identified self-reported use from the National Survey on Drug Use and Health, substance use treatment admissions from the Treatment Episode Data Set-Admissions, and overdose deaths from the CDC's Multiple Cause of Death files. MEASURES We measured rates of substance use, treatment, and deaths involving heroin, methamphetamine, and cocaine among United States adults from 2010 to 2019. RESULTS Heroin, methamphetamine, and cocaine use increased, though not all changes were statistically significant. Treatment admissions indicating heroin and methamphetamine increased while admissions indicating cocaine decreased. Overdose deaths increased among all groups: methamphetamine (257%-1,115%), heroin (211%-577%), and cocaine (88%-259%). Changes in rates of use, treatment, and death for specific substances varied by racial and ethnic group. CONCLUSIONS Substance use, treatment, and overdose mortality changed considerably, though not always equivalently. Identifying diverging trends in substance-related measures for specific substances and racial and ethnic groups can inform targeted investment in treatment to reduce disparities and respond to emerging changes in the overdose crisis.
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Affiliation(s)
- Riley D. Shearer
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Joel E. Segel
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA
- Consortium on Substance Use and Addiction, The Pennsylvania State University, University Park, PA
| | - Benjamin A. Howell
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT
| | - Abenaa A. Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA
| | - Utsha G. Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Teixeira da Silva
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Noel Vest
- Department of Anesthesia Stanford university School of Medicine, Stanford, CA
| | - Tyler N.A. Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN
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Avalone L, Lalane M, King C, Pfeiffer K, Linn-Walton R, Barron C. Integrating substance use peer support and screening brief intervention and referral to treatment services in the emergency department: a descriptive study of the ED leads program. Addict Sci Clin Pract 2024; 19:15. [PMID: 38419101 PMCID: PMC10902983 DOI: 10.1186/s13722-024-00445-x] [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: 03/13/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The ED Leads program was introduced to 11 emergency departments (EDs) within New York City public hospitals from 2018 to 2019 to address a need for addiction support services in the ED. The purpose of this study is to (i) describe the ED Leads blended licensed-clinician and peer counselor team model in the ED at three hospitals, (ii) provide a descriptive analysis of patient engagement and referrals to substance use disorder (SUD) care post-intervention, and (iii) highlight potential barriers and facilitators to implementing the model. METHODS The program intended to combine Screening Brief Intervention and Referral to Treatment and peer support services. The authors analyzed electronic medical records data for patients encountered by ED Leads in the first 120 days of program launch. Data included the outcome of an encounter when a patient was engaged with one or both staff types, and 7-day attendance at an SUD treatment appointment when a patient accepted a referral within the 11-hospital system. RESULTS There were 1785 patients approached by ED Leads staff during the study period. Engagement differed by staff type and patient demographics, and encounter outcomes varied significantly by hospital. Eighty-four percent (N = 1503) of patients who were approached engaged with at least one staff type, and 6% (N = 86) engaged with both. Patients were predominantly male (N = 1438, 81%) with an average age of 45 (SD = 13), and enrolled in Medicaid (N = 1062, 59%). A majority (N = 801, 45%) had alcohol use disorder. Of the patients who accepted a referral within the system (N = 433), 63% received treatment services within 7 days of the ED Leads encounter, a majority at detoxification treatment (N = 252, 58%). CONCLUSIONS This study describes the potential value and challenges of implementing a blended peer counselor and licensed clinician model in the ED to provide SUD services. While teams provided a high volume of referrals and the analysis of post-intervention treatment follow up is promising, the blended team model was not fully realized, making it difficult to assess the benefits of this combined service. Further research might examine patient outcomes among ED patients who are offered services by both a peer counselor and licensed clinician.
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Affiliation(s)
- Lynsey Avalone
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA.
| | - Monique Lalane
- NYC Health + Hospitals/Bellevue, 462 1st Avenue, New York City, NY, 10016, USA
| | - Carla King
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
| | - Kayna Pfeiffer
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
| | - Rebecca Linn-Walton
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
| | - Charles Barron
- NYC Health + Hospitals/Office of Behavioral Health, 50 Water Street, New York City, NY, 10004, USA
- Mt. Sinai Ichan School of Medicine, 1 Gustave L. Levy Pl, New York City, NY, 10029, USA
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Palau CB, Akikuni M, Latsky-Campbell B, Wagner J. The Drug Overdose Epidemic in the U.S.-Mexico Border Region: Shifts, Progression, and Community Characteristics. Subst Use Misuse 2023; 59:184-192. [PMID: 37888899 DOI: 10.1080/10826084.2023.2267110] [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] [Indexed: 10/28/2023]
Abstract
OBJECTIVE Previous studies show the reach of the current drug overdose epidemic into the U.S.-Mexico border region, albeit with a unique border-specific wave pattern compared to national waves and a delayed onset of fentanyl involvement (Wave I: 2002-2011, Wave II: 2012-2016, and Wave III: since 2017). The objective of this study is to examine the community predictors and the progression of overdose deaths across the U.S-Mexico border-specific epidemic waves. METHOD Descriptive epidemiological profile of border communities across the unfolding of the opioid epidemic, integrated data from the CDC-WONDER multiple causes of death data set, the CDC SVI, Uniform Crime Report, and the Behavioral Risk Factor Surveillance System. Using spatially adjusted Bayes rates by border-specific epidemic waves, we provide a descriptive profile of the spatial unfolding of the drug overdose epidemic. Negative binomial regression models assessed community predictors of overdose deaths across waves. RESULTS Spatial analysis identified moderate to steep increases in drug overdose deaths over the three waves along the border. The impact and unfolding of the epidemic in the U.S.-Mexico border region were not uniform and affecting communities with differing severity and timing. Our study also finds support for social vulnerability and community violence as predictors of overdose deaths over the current wave of the epidemic. CONCLUSION Findings suggest that more disadvantaged U.S.-Mexico border communities may encounter increasing rates of overdose death over the coming years. Interventions need to target not only the supply side but also the underlying social root causes for sustainable overdose prevention.
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Affiliation(s)
- Citlaly B Palau
- Department of Social Sciences, Texas A&M International University, Laredo, Texas, USA
| | - Mika Akikuni
- Department of Social Sciences, Texas A&M International University, Laredo, Texas, USA
| | | | - Jascha Wagner
- Department of Social Sciences, Texas A&M International University, Laredo, Texas, USA
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Douglass CH, Win TM, Goutzamanis S, Lim MSC, Block K, Onsando G, Hellard M, Higgs P, Livingstone C, Horyniak D. Stigma Associated with Alcohol and Other Drug Use Among People from Migrant and Ethnic Minority Groups: Results from a Systematic Review of Qualitative Studies. J Immigr Minor Health 2023; 25:1402-1425. [PMID: 36976449 PMCID: PMC10632266 DOI: 10.1007/s10903-023-01468-3] [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] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among migrant and ethnic minority groups. Qualitative studies published in English were identified using six databases. Two reviewers screened and critically appraised articles using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies. Data were synthesised using best fit framework synthesis. Twenty-three studies were included. Stigma drivers and facilitators included stereotypes, socio-cultural norms, legal responses and precarious lived experiences. Stigma intersected with gender, citizenship, race and ethnicity and manifested though shame, exclusion, secondary stigma and discrimination in treatment. Outcomes and impacts included avoidance of services, emotional distress, isolation and loneliness. This review identified similar stigma experiences to other populations, however outcomes were complicated by precarious lived experiences and multiple stigmatised identities. Multi-level interventions are required to reduce AOD-related stigma for migrant and ethnic minority groups.
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Affiliation(s)
- Caitlin H Douglass
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Thin Mar Win
- Burnet Institute Myanmar, 226 Wizaya Plaza, U Wisara Road, Yangon, Myanmar
| | | | - Megan S C Lim
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Karen Block
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Gerald Onsando
- Melbourne School of Social and Political Sciences, University of Melbourne, 420 John Medley Building, Parkville, VIC, 3010, Australia
| | - Margaret Hellard
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Peter Higgs
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Public Health Department, La Trobe University, Plenty Road, Bundoora, VIC, 3086, Australia
| | - Charles Livingstone
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Danielle Horyniak
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Gryczynski J, Sanchez K, Carswell SB, Schwartz RP. The Spanish language version of the TAPS tool: protocol for a validation and implementation study in primary care. Addict Sci Clin Pract 2023; 18:69. [PMID: 37974265 PMCID: PMC10652452 DOI: 10.1186/s13722-023-00423-9] [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: 04/27/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The TAPS Tool ("Tobacco, Alcohol, Prescription drug, and illicit Substance use") is a screening and brief assessment for detecting unhealthy substance use in healthcare settings that was developed by the National Institute on Drug Abuse Clinical Trials Network and validated in a multisite study. Our team developed a Spanish language version of the TAPS Tool that supports provider- and self-administration screening using a mobile/web-based platform, the TAPS Electronic Spanish Platform (TAPS-ESP). METHODS This article describes the protocol and rationale for a study to validate the TAPS-ESP in a sample of Spanish-speaking primary care patients recruited from a network of community-based clinics in Texas (target N = 1,000). The TAPS-ESP will be validated against established substance use disorder diagnostic measures, alternative screening tools, and substance use biomarkers. The study will subsequently examine barriers and facilitators to screening with the TAPS-ESP from a provider workflow perspective using qualitative interviews with providers. DISCUSSION Validating a Spanish language version of the TAPS Tool could expand access to evidence-based, linguistically accurate, and culturally relevant substance use screening and brief assessment for an underserved health disparity population. TRIAL REGISTRATION The study was registered with www. CLINICALTRIALS gov : NCT05476588, 07/22/2022.
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Affiliation(s)
- Jan Gryczynski
- Friends Research Institute, COG Analytics, Baltimore, MD, USA
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Cless MM, Courchesne-Krak NS, Bhatt KV, Mittal ML, Marienfeld CB. Craving among patients seeking treatment for substance use disorder. Discov Ment Health 2023; 3:23. [PMID: 37935934 PMCID: PMC10630178 DOI: 10.1007/s44192-023-00049-y] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Craving has been implicated as a central feature of addiction and a predictor of relapse. However, a complete understanding of how craving varies across patient populations is lacking. This study aimed to better inform the effective and accurate use of craving as a clinical prognostic tool for patients with substance use disorders (SUD). METHODS This cross-sectional study utilized information gathered on patients (n = 112) entering specialty treatment for a SUD. Craving in the prior 30 days was assessed with a single item with other intake questionnaires. RESULTS Patients who reported substance use in the last 30 days were more likely to report craving compared to patients who did not report substance use in the last 30 days (AOR = 6.86 [95% CI 2.17-21.7], p-value = 0.001). Patients who reported Hispanic/Latinx ethnicity were less likely to report craving compared to patients who did not report Hispanic/Latinx ethnicity (AOR = 0.28 [95% CI 0.08-0.95], p-value = 0.04). There was no association between craving and Adverse Childhood Events (OR = 1.03 [95% CI 0.84-1.25], p-value = 0.81). CONCLUSION The association between recent substance use and craving supports previous findings. The observed variation in craving among patients who report Hispanic/Latinx ethnicity is novel and suggests socio-cultural influences and possibly genetic factors influencing reported craving amongst patients. Additional research is needed to further understand the underlying factors leading to this finding, in order for better utilization of craving as a clinical indicator across patient populations.
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Affiliation(s)
- Mallory M Cless
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA
| | - Natasia S Courchesne-Krak
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA
| | - Kush V Bhatt
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA
| | - Maria Luisa Mittal
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA
| | - Carla B Marienfeld
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C101, La Jolla, CA, 92037, USA.
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Hospital MM, Contreras-Pérez ME, Alessi SM, Langwerden RJ, Morris SL, Wagner EF. Mindfulness as an early intervention for hazardous alcohol use among non-treatment seeking Latine emerging adults: A mini-review. Addict Behav 2023; 145:107759. [PMID: 37276788 DOI: 10.1016/j.addbeh.2023.107759] [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: 12/05/2022] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
The age cohort referred to as emerging adults (ages 18-29 years old) demonstrates the most hazardous alcohol use in the United States (U.S.) Approximately one-third of emerging adults regularly engage in heavy episodic drinking (4/5 drinks in two hours females/males). Compared to their non-Latine White peers, Latine emerging adults in the U.S. report lower rates of heavy episodic drinking (HED) yet are at greater risk of developing a substance use disorder and experience more severe negative consequences from drinking alcohol. Despite their high-risk status, Latine emerging adults are less likely to seek treatment and have less access to innovative health-promoting resources, further exacerbating health inequities. Research has shown that practicing mindfulness can interrupt habituated cognitions, intrusive thinking, and automatic behaviors associated with hazardous drinking. However, Latine representation in MBI trials is minimal. This mini-review explores the potential value of mindfulness as an early intervention for hazardous alcohol use among Latine emerging adults. The review provides future directions for research, highlighting the need to design culturally and developmentally tailored MBIs that can provide a respectful, non-judgmental, and discrimination-free environment that appeals to Latine emerging adults. Additionally, conclusions are drawn regarding the possible benefits of pairing MBI with contingency management strategies to decrease attrition rates in MBI trials.
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Affiliation(s)
- Michelle M Hospital
- Community-Based Research Institute, Florida International University, Miami, FL 33199, USA; Research Center in a Minority Institution, Florida International University, Miami, FL 33199, USA; Department of Biostatistics, Florida International University, Miami, FL 33199, USA.
| | - María Eugenia Contreras-Pérez
- Community-Based Research Institute, Florida International University, Miami, FL 33199, USA; Research Center in a Minority Institution, Florida International University, Miami, FL 33199, USA; School of Social Work, Florida International University, Miami, FL 33199, USA.
| | - Sheila M Alessi
- Department of Medicine and the Calhoun Cardiology Center - Behavioral Health Division, University of Connecticut School of Medicine, Farmington, CT 06030-3944, USA.
| | - Robbert J Langwerden
- Community-Based Research Institute, Florida International University, Miami, FL 33199, USA; Research Center in a Minority Institution, Florida International University, Miami, FL 33199, USA.
| | - Staci Leon Morris
- Community-Based Research Institute, Florida International University, Miami, FL 33199, USA; Research Center in a Minority Institution, Florida International University, Miami, FL 33199, USA; School of Social Work, Florida International University, Miami, FL 33199, USA.
| | - Eric F Wagner
- Community-Based Research Institute, Florida International University, Miami, FL 33199, USA; Research Center in a Minority Institution, Florida International University, Miami, FL 33199, USA; School of Social Work, Florida International University, Miami, FL 33199, USA.
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Courchesne-Krak NS, Marienfeld CB, Kepner W. What Brings You in Today? Sex, Race, Substance Type, and Other Sociodemographic and Health-Related Characteristics Predict if Substance Use is the Main Reason for a Clinical Encounter. Yale J Biol Med 2023; 96:277-291. [PMID: 37780998 PMCID: PMC10524817 DOI: 10.59249/udrg5942] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: Substance-related diagnoses (SRDs) are a common healthcare presentation. This study identified sociodemographic and health-related characteristics associated with having an SRD as the primary reason for a clinical encounter compared to those with an SRD who are treated for other reasons. Methods: Electronic health record (EHR) data on patients with an SRD (n=12,358, ages 18-90) were used to assess if an SRD was the primary reason for a clinical encounter from January 1, 2012-January 1, 2018. Patients were matched on key demographic characteristics at a 1:1 ratio. Adjusting for covariates, odds ratios, and 95% confidence intervals were calculated. Results: In the matched cohort of 8,630, most reported male sex (65.8%), White race (70.0%), and single marital status (62.7%) with a mean age of 47.2 (SD=14.6). Patient reported female sex, Black race, age 70+, married status, and low-income (<$50,000) were associated with a lower likelihood of presenting to care for an SRD as the primary reason for a clinical encounter. A nicotine-, alcohol-, opioid-, or stimulant-related diagnosis was associated with a higher likelihood of presenting to care for an SRD as the primary reason for the clinical visit. Conclusion: This is the first study to investigate whether sociodemographic and health-related characteristics were associated with having an SRD as the primary reason for a clinical encounter. Using rigorous methods, we investigated a unique clinical question adding new knowledge to predictors of patients seeking clinical care. Understanding these predictors can help us better align service provision with population needs and inform new approaches to tailoring care.
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Affiliation(s)
| | - Carla B. Marienfeld
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,
USA
| | - Wayne Kepner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,
USA
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11
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Pinedo M, Castro Y, Gilbert PA, Caetano R, Zemore SE. Improving assessment of alcohol treatment barriers among Latino and White adults with an alcohol use disorder: Development of the barriers to specialty alcohol treatment scale. Drug Alcohol Depend 2023; 248:109895. [PMID: 37156194 PMCID: PMC10802933 DOI: 10.1016/j.drugalcdep.2023.109895] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The present study's aims were two-fold. First, we sought to validate a novel measure to assess barriers to specialty alcohol treatment among White and Latino individuals with an alcohol use disorder (AUD): The Barriers to Specialty Alcohol Treatment (BSAT) scale. Second, we sought to demonstrate that the BSAT scale could be used to explain Latino-White disparities in barriers to alcohol treatment. METHODS In 2021, we recruited an online national sample of 1200 White and Latino adults with a recent AUD. Participants completed an online questionnaire that included the BSAT items. Confirmatory and exploratory factor analyses were conducted to validate the BSAT. Multiple group analyses across race/ethnicity and language were also performed using the final model. RESULTS The final model consisted of 36 items across 7 factors that reflect barriers related to low problem recognition, recovery goals, low perceived treatment efficacy, cultural factors, immigration-related concerns, low perceived social support, and logistical barriers. The final model's factor structure and factor loadings held up across race/ethnicity and language. The top endorsed barriers were low problem recognition, recovery goals, low perceived social support, logistical issues, and low perceived treatment efficacy. Compared to Whites, Latinos were more likely to report perceived lack of social support, logistical barriers, low perceived treatment efficacy, cultural barriers, and immigration-related concerns as barriers. CONCLUSION Findings provide empirical support for the validity of the BSAT scale, which offers improved measurement of specialty alcohol treatment barriers and can be used to explore Latino-White disparities in a future study.
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Affiliation(s)
- M Pinedo
- Kinesiology & Health Education, UT Austin, United States.
| | - Y Castro
- Steve Hicks School of Social Work, UT Austin, United States
| | - P A Gilbert
- College of Public Health, University of Iowa, United States
| | - R Caetano
- Pacific Institute for Research and Evaluation, United States
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Jones AA, Shearer RD, Segel JE, Santos-Lozada A, Strong-Jones S, Vest N, Teixeira da Silva D, Khatri UG, Winkelman TNA. Opioid and stimulant attributed treatment admissions and fatal overdoses: Using national surveillance data to examine the intersection of race, sex, and polysubstance use, 1992-2020. Drug Alcohol Depend 2023; 249:109946. [PMID: 37354584 PMCID: PMC10375360 DOI: 10.1016/j.drugalcdep.2023.109946] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/15/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND We use national surveillance data to evaluate race/ethnicity by sex/gender differences and trends in substance use treatment admissions and overdose deaths involving opioid and stimulant use. METHODS We used data (1992-2019) from the Treatment Episode Dataset-Admissions to identify treatment admissions and the Center for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (1999-2020) to identify overdose deaths. We assessed treatment admissions and related drug overdose deaths per 100,000 adults by sex and race/ethnicity for opioid and stimulant groups: cocaine, opioid, methamphetamines, cocaine and opioid use, cocaine and methamphetamines, and opioid and methamphetamines. RESULTS We found significant variations in treatment admissions and deaths by race/ethnicity and sex/gender. Cocaine-related treatment admissions and deaths were most prevalent among Non-Hispanic Black individuals over the study years, yet lower rates were evident among individuals from other racial/ethnic groups. Notably, Non-Hispanic Black men experienced larger increases in cocaine-only admissions than men of other racial/ethnic groups between 1992 and 2019. Men had higher opioid and stimulant treatment admissions and overdose deaths than women. We observed skyrocketing methamphetamine deaths among American Indian/Native Alaskan men and women from 1992 to 2019. DISCUSSION Steep increases in overdose deaths fueled by methamphetamines among Non-Hispanic Native Americans and cocaine among Non-Hispanic Black individuals suggest a need for more effective interventions to curb stimulant use. Variations by race/ethnicity and sex/gender also suggest interventions should be developed through an intersectionality lens.
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Affiliation(s)
- A A Jones
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA; Consortium for Substance Use and Addiction, The Pennsylvania State University, University Park, PA16801, USA.
| | - R D Shearer
- Department of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - J E Segel
- Consortium for Substance Use and Addiction, The Pennsylvania State University, University Park, PA16801, USA; Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA16801, USA; Department of Public Health Sciences, The Pennsylvania State University, University Park, PA16801, USA
| | - A Santos-Lozada
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA
| | - S Strong-Jones
- Department of Human Development and Family Studies and Family Studies, The Pennsylvania State University, University Park, PA16801, USA
| | - N Vest
- Department of Community and Health Sciences, School of Public Health, Boston University, Boston, MA02118, USA
| | - D Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, USA
| | - U G Khatri
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - T N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN 55415, USA; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN 55415, USA
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Zhen-Duan J, Colombo D, Alvarez K. Inclusion of Expanded Adverse Childhood Experiences in Research About Racial/Ethnic Substance Use Disparities. Am J Public Health 2023; 113:S129-S132. [PMID: 37339415 PMCID: PMC10282858 DOI: 10.2105/ajph.2023.307220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 06/22/2023]
Affiliation(s)
- Jenny Zhen-Duan
- Jenny Zhen-Duan is with the Departments of Psychiatry and Medicine, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, MA. Daniella Colombo is with Rutgers New Jersey Medical School, Newark, NJ. Kiara Alvarez is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniella Colombo
- Jenny Zhen-Duan is with the Departments of Psychiatry and Medicine, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, MA. Daniella Colombo is with Rutgers New Jersey Medical School, Newark, NJ. Kiara Alvarez is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kiara Alvarez
- Jenny Zhen-Duan is with the Departments of Psychiatry and Medicine, Massachusetts General Hospital, and the Department of Psychiatry, Harvard Medical School, Boston, MA. Daniella Colombo is with Rutgers New Jersey Medical School, Newark, NJ. Kiara Alvarez is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Palzes VA, Chi FW, Metz VE, Sterling S, Asyyed A, Ridout KK, Campbell CI. Overall and Telehealth Addiction Treatment Utilization by Age, Race, Ethnicity, and Socioeconomic Status in California After COVID-19 Policy Changes. JAMA Health Forum 2023; 4:e231018. [PMID: 37204804 PMCID: PMC10199344 DOI: 10.1001/jamahealthforum.2023.1018] [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] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/21/2023] [Indexed: 05/20/2023] Open
Abstract
Importance Addiction treatment rapidly transitioned to a primarily telehealth modality (telephone and video) during the COVID-19 pandemic, raising concerns about disparities in utilization. Objective To examine whether there were differences in overall and telehealth addiction treatment utilization after telehealth policy changes during the COVID-19 pandemic by age, race, ethnicity, and socioeconomic status. Design, Setting, and Participants This cohort study examined electronic health record and claims data from Kaiser Permanente Northern California for adults (age ≥18 years) with drug use problems before the COVID-19 pandemic (from March 1, 2019, to December 31, 2019) and during the early phase of the COVID-19 pandemic (March 1, 2020, to December 31, 2020; hereafter referred to as COVID-19 onset). Analyses were conducted between March 2021 and March 2023. Exposure The expansion of telehealth services during COVID-19 onset. Main Outcomes and Measures Generalized estimating equation models were fit to compare addiction treatment utilization during COVID-19 onset with that before the COVID-19 pandemic. Utilization measures included the Healthcare Effectiveness Data and Information Set of treatment initiation and engagement (including inpatient, outpatient, and telehealth encounters or receipt of medication for opioid use disorder [OUD]), 12-week retention (days in treatment), and OUD pharmacotherapy retention. Telehealth treatment initiation and engagement were also examined. Differences in changes in utilization by age group, race, ethnicity, and socioeconomic status (SES) were examined. Results Among the 19 648 participants in the pre-COVID-19 cohort (58.5% male; mean [SD] age, 41.0 [17.5] years), 1.6% were American Indian or Alaska Native; 7.5%, Asian or Pacific Islander; 14.3%, Black; 20.8%, Latino or Hispanic; 53.4%, White; and 2.5%, unknown race. Among the 16 959 participants in the COVID-19 onset cohort (56.5% male; mean [SD] age, 38.9 [16.3] years), 1.6% were American Indian or Alaska Native; 7.4%, Asian or Pacific Islander; 14.6%, Black; 22.2%, Latino or Hispanic; 51.0%, White; and 3.2%, unknown race. Odds of overall treatment initiation increased from before the COVID-19 pandemic to COVID-19 onset for all age, race, ethnicity, and SES subgroups except for patients aged 50 years or older; patients aged 18 to 34 years had the greatest increases (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22-1.40). Odds of telehealth treatment initiation increased for all patient subgroups without variation by race, ethnicity, or SES, although increases were greater for patients aged 18 to 34 years (aOR, 7.17; 95% CI, 6.24-8.24). Odds of overall treatment engagement increased (aOR, 1.13; 95% CI, 1.03-1.24) without variation by patient subgroups. Retention increased by 1.4 days (95% CI, 0.6-2.2 days), and OUD pharmacotherapy retention did not change (adjusted mean difference, -5.2 days; 95% CI, -12.7 to 2.4 days). Conclusions In this cohort study of insured adults with drug use problems, there were increases in overall and telehealth addiction treatment utilization after telehealth policies changed during the COVID-19 pandemic. There was no evidence that disparities were exacerbated, and younger adults may have particularly benefited from the transition to telehealth.
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Affiliation(s)
- Vanessa A. Palzes
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Felicia W. Chi
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Verena E. Metz
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacy Sterling
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Asma Asyyed
- Northern California Addiction Medicine and Recovery Services, The Permanente Medical Group, Inc, Santa Rosa
| | - Kathryn K. Ridout
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- The Permanente Medical Group, Inc, Santa Rosa, California
| | - Cynthia I. Campbell
- Center for Addiction and Mental Health Research, Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Razaghi E, Farhoudian A, Pilevari A, Noroozi A, Hooshyari Z, Radfar R, Malekinejad M. Identification of the socio-cultural barriers of drug addiction treatment in Iran. Heliyon 2023; 9:e15566. [PMID: 37131427 PMCID: PMC10149210 DOI: 10.1016/j.heliyon.2023.e15566] [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: 08/18/2022] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023] Open
Abstract
Introduction Socio-cultural norms can either be encouraging or a barrier to addiction treatment. More, rigorous research is needed on nonindigenous models in addiction treatment, to better understand the role of socio-cultural differences. Methods The present qualitative study is part of the project, "The Inclusive Assessment of the Barriers of Drug Addiction Treatment Services in Iran," which was conducted in Tehran from 2018 to 2021. The participants consisted of eight people who used drugs, seven individual family members of the people who used drugs participants, seven service providers, and four policymakers. A purposeful sampling method was used for the selection of the participants, and the process continued until reaching the theoretical saturation of data. Analysis used the Graneheim and Lundman methods, classifying primary codes, the sub-themes, and themes were classified according to the similarities and differences between primary codes. Finding The most important socio-cultural barriers to addiction treatment in Iran are: unrealistic expectations of the family and society from the people who use drugs, addiction stigma, mistrust between various components of the treatment system, perceptions that professional substance use disorder treatment is inefficient and low uptake of that treatment, the disturbed relational boundaries between the people who use drugs and their relatives, the interweaving of treatment and ethical and religious principles, low acceptance of maintenance treatments, treatment focusing on short-term outcomes, and presence of facilitating backgrounds of using drugs. Conclusions The Iranian socio-cultural characteristics play an important role in the addiction treatment of the people who use drugs, so it is necessary for treatment interventions to be sensitive to these characteristics.
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Affiliation(s)
- Emran Razaghi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Farhoudian
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Pilevari
- Department of Sociology, Kharazmi University, Karaj, Iran
- Corresponding author.
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Science, Tehran, Iran
| | - Zahra Hooshyari
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Radfar
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Malekinejad
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, USA
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Bremer W, Plaisance K, Walker D, Bonn M, Love JS, Perrone J, Sarker A. Barriers to opioid use disorder treatment: A comparison of self-reported information from social media with barriers found in literature. Front Public Health 2023; 11:1141093. [PMID: 37151596 PMCID: PMC10158842 DOI: 10.3389/fpubh.2023.1141093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/21/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Medications such as buprenorphine and methadone are effective for treating opioid use disorder (OUD), but many patients face barriers related to treatment and access. We analyzed two sources of data-social media and published literature-to categorize and quantify such barriers. Methods In this mixed methods study, we analyzed social media (Reddit) posts from three OUD-related forums (subreddits): r/suboxone, r/Methadone, and r/naltrexone. We applied natural language processing to identify posts relevant to treatment barriers, categorized them into insurance- and non-insurance-related, and manually subcategorized them into fine-grained topics. For comparison, we used substance use-, OUD- and barrier-related keywords to identify relevant articles from PubMed published between 2006 and 2022. We searched publications for language expressing fear of barriers, and hesitation or disinterest in medication treatment because of barriers, paying particular attention to the affected population groups described. Results On social media, the top three insurance-related barriers included having no insurance (22.5%), insurance not covering OUD treatment (24.7%), and general difficulties of using insurance for OUD treatment (38.2%); while the top two non-insurance-related barriers included stigma (47.6%), and financial difficulties (26.2%). For published literature, stigma was the most prominently reported barrier, occurring in 78.9% of the publications reviewed, followed by financial and/or logistical issues to receiving medication treatment (73.7%), gender-specific barriers (36.8%), and fear (31.5%). Conclusion The stigma associated with OUD and/or seeking treatment and insurance/cost are the two most common types of barriers reported in the two sources combined. Harm reduction efforts addressing barriers to recovery may benefit from leveraging multiple data sources.
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Affiliation(s)
- Whitney Bremer
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
- Department of Biomedical Informatics, School of Medicine, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
| | - Karma Plaisance
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Drew Walker
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Jennifer S. Love
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Abeed Sarker
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
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Moyce S, Claudio D, Velazquez M. Using the PDCA cycle to uncover sources of mental health disparities for Hispanics. Int J Ment Health Nurs 2023; 32:556-566. [PMID: 36533717 DOI: 10.1111/inm.13100] [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] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
The Hispanic population is growing rapidly in U.S. rural states, yet limitations in Spanish-speaking behavioural health providers are a barrier to accessing care. In Montana, a new immigrant destination, mental health disparities may not yet be fully understood. We describe an interprofessional approach of nurses and engineers using the Plan-Do-Check-Act (PDCA) cycle to identify disparities in mental health access in a Hispanic community in a rural state. We recruited a community advisory board to inform researchers about potential disparities and to design interventions. The Plan phase consisted of naming the problem and its root causes. Researchers and a community advisory board created flowsheets and diagrams to uncover personal, environmental, political, and procedural contributors to poor mental health outcomes. The Do phase included implementation of a community screening for depression and anxiety. The Check phase revealed 43 mental health screenings where 21% screened positive for depression and 16% screened positive for anxiety. We made 16 referrals to a mental health intervention study. The Act phase led to plans for regular implementation of the health fairs and a study designed to provide Spanish-language mental health services. The success of our interprofessional work provides an example of how the PDCA cycle can be used to uncover potential causes for poor health outcomes and design and evaluate interventions targeted to mitigate those outcomes.
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Affiliation(s)
- Sally Moyce
- Mark and Robyn Jones College of Nursing, Montana State University, Bozeman, Montana, USA
| | - David Claudio
- Francis College of Engineering, University of Massachusetts, Lowell, Massachusetts, USA
| | - Maria Velazquez
- Francis College of Engineering, University of Massachusetts, Lowell, Massachusetts, USA
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Zvolensky MJ, Shepherd JM, Clausen BK, Garey L, Kauffman BY, Viana AG, Heggeness LF, Bizier A, Zappi C, Reitzel LR. Smoking Abstinence Expectancies Among Latinx Smokers: An Initial Test and Evaluation of Individual Difference Factors. Cogn Ther Res 2023. [DOI: 10.1007/s10608-023-10351-2] [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: 02/07/2023]
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Muroff J, Do D, Brinkerhoff CA, Chassler D, Cortes MA, Baum M, Guzman-Betancourt G, Reyes D, López LM, Roberts M, De Jesus D, Stewart E, Martinez LS. Nuestra Recuperación [Our Recovery]: using photovoice to understand the factors that influence recovery in Latinx populations. BMC Public Health 2023; 23:81. [PMID: 36631802 PMCID: PMC9832608 DOI: 10.1186/s12889-023-14983-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Photovoice is a form of visual ethnography intended to engage impacted communities in research followed by action to ameliorate the injustices under study. Photovoice has increased in use, especially in collaboration with Latinx communities addressing health inequities. The Latinx population comprises nearly 18% of the overall United States population and according to the census is projected to reach just under 30% by 2060. This diverse panethnic community faces significant structural barriers in accessing services. Racism and the resulting marginalization, specifically, contributes to limited access to recovery services and treatment. Making meaningful advances in substance use disorder training, intervention and policy necessitates learning alongside the Latinx community. METHODS We partnered with a Latinx serving integrated behavioral health and primary care setting in Boston Massachusetts to explore barriers and facilitators to recovery using photovoice. Spanish-speaking Latinx adults with a substance use disorder participated. The group met for three photovoice sessions over a six-week period. Together group members critically analyzed photographs using the SHOWeD method. RESULTS Findings indicate a sense of purpose and meaning, security, faith and housing are important elements of recovery. The results illustrated the importance of sources of connection in maintaining sobriety. Through this photovoice project, Latinx Spanish speaking participants highlighted barriers and facilitators to their substance use disorder recovery which spanned individual, community, and structural levels. CONCLUSIONS The experiences and voices of the Latinx community are crucial to drive discussions that advance policy (e.g., housing stability and access), enhance providers' understanding of Latinx Spanish-speakers' substance use disorder recovery, and inform culturally and linguistically appropriate services. This study demonstrated that photovoice is highly acceptable and feasible among Latinx clients receiving substance use disorder services. Visual images related to housing, faith, etc. communicate challenges, power structures, as well as hopes to policymakers at multiple levels (e.g., institution/ agency, state).
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Affiliation(s)
- Jordana Muroff
- School of Social Work, Boston University, Boston, MA, USA.
| | - Daniel Do
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
| | | | - Deborah Chassler
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
| | - Myrna Alfaro Cortes
- grid.189504.10000 0004 1936 7558School of Public Health, Boston University, Boston, MA USA
| | - Michelle Baum
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
| | | | - Daniela Reyes
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
| | - Luz M. López
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
| | | | | | | | - Linda Sprague Martinez
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
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Ferguson E, Lewis B, Teitelbaum S, Reisfield G, Robinson M, Boissoneault J. Longitudinal associations between pain and substance use disorder treatment outcomes. J Subst Abuse Treat 2022; 143:108892. [PMID: 36228338 PMCID: PMC11025107 DOI: 10.1016/j.jsat.2022.108892] [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: 12/08/2021] [Revised: 07/29/2022] [Accepted: 09/19/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Pain is commonly reported among those in treatment for substance use disorders (SUD) and is associated with poorer SUD treatment outcomes. The current study examined the trajectory of pain over the course of SUD treatment and associations with substance use outcomes. METHODS This observational study included adults seeking treatment for alcohol, cannabis, or opioid use disorders (N = 811). Participants completed a battery of assessments at treatment admission, 30 days post admission, and at discharge, including measures of demographics, pain, quality of life, abstinence self-efficacy, and craving. RESULTS Analyses indicated linear reductions in pain intensity and interference over time. Significant interactive effects were observed for opioid use disorder (OUD) and time, such that participants with OUD had greater reductions in pain intensity and interference over time compared to those without OUD. Elevated pain intensity was associated with negative treatment outcomes, including reduced quality of life and abstinence self-efficacy, and greater craving and negative affect. CONCLUSIONS Reductions in pain occur over the course of SUD treatment, particularly for those with OUD. Greater pain was also associated with adverse SUD treatment outcomes. Results suggest that treatment and associated abstinence may be beneficial for those with co-occurring pain and SUD, highlighting an additional benefit of improving access to SUD treatment for patients and health care systems. Future research should replicate these findings among diverse samples and further characterize the trajectory of pain during and after SUD treatment.
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Affiliation(s)
- Erin Ferguson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Ben Lewis
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Scott Teitelbaum
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Gary Reisfield
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA.
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Tomko C, Olfson M, Mojtabai R. Gaps and barriers in drug and alcohol treatment following implementation of the affordable care act. Drug Alcohol Depend Rep 2022; 5:100115. [PMID: 36644223 PMCID: PMC9835109 DOI: 10.1016/j.dadr.2022.100115] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background This study examines changes in the substance use disorder (SUD) treatment gap and barriers to treatment for low-income adults following Affordable Care Act (ACA) implementation. Methods National Survey on Drug Use and Health (NSDUH) data were pooled to assess pre-ACA (2009-2013) and post-ACA (2015-2019) implementation. The sample (n = 44,622) included respondents 18-64 years old, income <200% federal poverty level, and meeting SUD criteria for abuse or dependence of heroin, powdered cocaine, crack cocaine, marijuana, or alcohol. The primary outcome was NSDUH-defined past-year illicit drug or alcohol treatment gap (needing but not receiving SUD specialty treatment). A secondary analysis assessed barriers to SUD treatment including insurance-related barriers, stigma, barriers to access, priority of treatment, and no interest in stopping substance use. Results Ninety-three percent of respondents reported a drug or alcohol treatment gap before and after ACA implementation. No interest in stopping use was the greatest barrier (40%), followed by insurance-related barriers (39%) and stigma (20%). After adjusting for covariates, results did not show a significant change in SUD treatment gap post-ACA compared to pre-ACA (adjusted odds ratio [aOR]=1.11, 95% confidence interval [CI]=0.97, 1.28, p = 0.13). Compared to pre-ACA, odds of reporting stigma-related barriers (aOR=1.66, 95% CI=1.17, 2.37, p = 0.01) and access-related barriers (aOR=1.79, 95% CI=1.34, 2.38, p < 0.001) increased post-ACA. Conclusions There was no significant change in the prevalence of SUD treatment gap after ACA implementation. Increasing access to SUD treatment for low-income individuals will require intervening at multiple socioecological levels beyond reforming treatment financing.
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Affiliation(s)
- Catherine Tomko
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 161, Baltimore, MD 21205, USA,Corresponding author. (C. Tomko)
| | - Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York NY 10032, USA,Mailman School of Public Health, Columbia University, 722 W 168th St., New York, NY 10032, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 161, Baltimore, MD 21205, USA,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD 21205, USA
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22
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Martin CE, Parlier-Ahmad AB, Beck L, Scialli A, Terplan M. Need for and Receipt of Substance Use Disorder Treatment Among Adults, by Gender, in the United States. Public Health Rep 2022; 137:955-963. [PMID: 34546835 PMCID: PMC9379831 DOI: 10.1177/00333549211041554] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 12/21/2020] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Disparities in substance use disorder (SUD) treatment use persist across groups, including gender. Using a gender-informed approach to expand treatment capacity and reduce barriers to treatment engagement is vital. We examined SUD treatment need and receipt among people with SUD in the United States, by gender, and assessed gender-specific sociodemographic factors associated with unmet need for SUD treatment and reported treatment barriers. METHODS We conducted an analysis of data among adults aged ≥18 with a past-year SUD from the National Survey on Drug Use and Health (2015-2018). We computed population-adjusted frequencies and proportions for SUD treatment need and receipt and assessed gender differences. Multivariate logistic regression assessed gender-specific sociodemographic variables associated with SUD treatment receipt. RESULTS Among adults with a past-year SUD, 63.4% were men and 36.6% were women (P < .001), only 10.6% received SUD treatment, and a greater percentage of women than men needed treatment for opioid use disorder (11.9% vs 9.9%; P = .002). Receipt of SUD treatment was lowest among women with alcohol use disorder followed by men with alcohol use disorder (7.5% vs 8.9%; P = .052). Non-Latinx Black men had fewer than half the adjusted odds of receiving SUD treatment than non-Latinx White men (adjusted odds ratio [aOR] = 0.44; 95% CI, 0.27-0.71). Latinx women (aOR = 0.37; 95% CI, 0.18-0.73) and non-Latinx Black women (aOR = 0.51; 95% CI, 0.27-0.94) had significantly lower odds of receiving SUD treatment than non-Latinx White women. CONCLUSIONS As public health efforts target expanding SUD treatment capacity and addressing disparities in use of SUD treatment, interventions informed by gender and culture should be prioritized.
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Affiliation(s)
- Caitlin E. Martin
- Department of Obstetrics and Gynecology, School of Medicine
& Institute for Drug and Alcohol Studies, Virginia Commonwealth University,
Richmond, VA, USA
| | | | - Lori Beck
- Department of Family Medicine and Population Health, Virginia
Commonwealth University, Richmond, VA, USA
| | - Anna Scialli
- College of Humanities and Sciences, Virginia Commonwealth
University, Richmond, VA, USA
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Gray AC, Neitzke-Spruill L, Hughes C, O'Connell DJ, Anderson TL. Opioid-stimulant trends in overdose toxicology by race, ethnicity, & gender: An analysis in Delaware, 2013-2019. J Ethn Subst Abuse 2022:1-30. [PMID: 35973048 DOI: 10.1080/15332640.2022.2109790] [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] [Indexed: 10/15/2022]
Abstract
Recent upticks of stimulant presence in overdose deaths suggest the opioid epidemic is morphing, which raises questions about what drugs are involved and who is impacted. We investigate annual and growth rate trends in combined opioid-stimulant overdose toxicology between 2013 and 2019 for White, Black, and Hispanic male and female decedents in Delaware. During these years, toxicology shifted to illegal drugs for all with fentanyl leading the increase and opioid-cocaine combinations rising substantially. While combined opioid-cocaine toxicology grew among Black and Hispanic Delawareans, White males continue to report the highest rates overall. These findings depart from historical patterns and may challenge existing opioid epidemic policies.
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Affiliation(s)
| | | | | | - Daniel J O'Connell
- Center for Drug and Health Studies, University of Delaware, Newark, Delaware
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24
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Morris SL, Langwerden RJ, Wagner EF, Hospital MM. Implementation of a brief motivational intervention for alcohol and other drug using Latinx college students. J Am Coll Health 2022:1-11. [PMID: 35816752 PMCID: PMC9873229 DOI: 10.1080/07448481.2022.2090258] [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] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 05/11/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Alcohol and other drug (AOD) use problems among college students continue to represent a public health epidemic. In 2019, historically high rates of binge-drinking and marijuana use were reported among college-age adults, and the detrimental effects of excessive AOD use in college, such as poorer academic performance, sexual assault, injury or overdoses, and a range of other negative consequences, have been well-documented. Thus, there is a continued need for effective implementation of evidence-based, cost-effective interventions aimed at reducing risks associated with collegiate AOD use. Guided Self Change (GSC) is a brief intervention involving motivational enhancement and cognitive-behavioral strategies and has demonstrated effectiveness in reducing AOD use problems. Its brevity, client-driven style, and concrete here-and-now focus are appealing to individuals struggling with mild to moderate AOD use problems. In order to successfully intervene with collegians with AOD use problems attending minority-serving institutions, GSC requires developmental and cultural tailoring. The current report describes the developmental and cultural tailoring of GSC for emerging adult Latinx collegians, as well as our consumer-driven addition of mindfulness content. Key components of our GSC program are documented through qualitative feedback, quantitative results, and case vignettes.
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Affiliation(s)
- Staci L Morris
- Community-Based Research Institute (CBRI), Florida International University, Miami, FL, USA
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Robbert J Langwerden
- Community-Based Research Institute (CBRI), Florida International University, Miami, FL, USA
| | - Eric F Wagner
- Community-Based Research Institute (CBRI), Florida International University, Miami, FL, USA
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Michelle M Hospital
- Community-Based Research Institute (CBRI), Florida International University, Miami, FL, USA
- Department of Biostatistics, Florida International University, Miami, FL, USA
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25
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Moreno O, Williams CD, Muñoz G, Elias MDJ, Santana A, Fuentes L, Garcia-Rodriguez I, Hernandez C, Hood K, Johnson KF, Montemayor BN, Chartier K, Amstadter A, Dick DM, Lilley E, Gelzinis R, Morris A, Bountress K, Adkins AE, Thomas N, Neale Z, Pedersen K, Bannard T, Cho SB, Adkins AE, Pedersen K, Barr P, Byers H, Berenz EC, Caraway E, Cho SB, Clifford JS, Cooke M, Do E, Edwards AC, Goyal N, Hack LM, Halberstadt LJ, Hawn S, Kuo S, Lasko E, Lend J, Lind M, Long E, Martelli A, Meyers JL, Mitchell K, Moore A, Moscati A, Nasim A, Neale Z, Opalesky J, Overstreet C, Pais AC, Pedersen K, Raldiris T, Salvatore J, Savage J, Smith R, Sosnowski D, Su J, Thomas N, Walker C, Walsh M, Willoughby T, Woodroof M, Yan J, Sun C, Wormley B, Riley B, Aliev F, Peterson R, Webb BT, Vassileva J, Dick DM, Amstadter AB. Moderating Role of Healthcare Disruptions on Friend and Family Pandemic-Related Negative Life Events Predicting Latines’ Anxiety and Alcohol Use Over Time. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00853-7] [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: 11/29/2022] Open
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26
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Carey CM, Williams EC, Torres VN, Ornelas IJ. Help-Seeking Patterns and Barriers to Care Among Latino Immigrant Men with Unhealthy Alcohol Use. J Racial Ethn Health Disparities 2022; 9:1003-1011. [PMID: 33834422 PMCID: PMC8497645 DOI: 10.1007/s40615-021-01039-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/29/2023]
Abstract
Latino immigrant men have high rates of unhealthy alcohol use, a wide range of behaviors, from drinking above the recommended limits to severe alcohol use disorder, yet have low levels of treatment-seeking. Little is known about their preferred sources of care and barriers to care. Using survey data from a community-based sample of Latino immigrant men (N=121) with unhealthy alcohol use (AUDIT≥6), we described help-seeking patterns and perceived barriers to care. The mean AUDIT score was 20 (SD 10; range 6-40), and 49% of men had severe levels of unhealthy alcohol use (AUDIT score ≥ 20). We observed low help-seeking rates and high levels of perceived internal and external barriers. Thirty percent reported having sought help for drinking. Most men reported wanting to solve their drinking problem on their own (65%). Our findings were consistent with previous research. Future studies should further describe barriers to treatment among low-income Latino immigrant men with unhealthy alcohol use and identify ways to increase access to low-cost, high-quality treatment options.
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Affiliation(s)
- Cathea M. Carey
- Department of Health Services, University of Washington, Seattle, Washington
| | - Emily C. Williams
- U.S. Department of Veteran Affairs (V.A.) Health Services Research and Development (HSR&D) Seattle-Denver Center of Innovation (COIN), Seattle, Washington;,Department of Health Services, University of Washington, Seattle, Washington
| | - Vanessa N. Torres
- Department of Health Policy and Management, University of California, Los Angeles;,Department of Behavioral and Policy Sciences, RAND Corporation
| | - India J. Ornelas
- Department of Health Services, University of Washington, Seattle, Washington
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27
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Torres VN, Williams EC, Ceballos RM, Donovan DM, Ornelas IJ. Discrimination, acculturative stress, alcohol use and their associations with alcohol-related consequences among Latino immigrant men. J Ethn Subst Abuse 2022; 23:150-165. [PMID: 35634786 DOI: 10.1080/15332640.2022.2077273] [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] [Indexed: 10/18/2022]
Abstract
Latino immigrant men are at increased risk for unhealthy alcohol use and related consequences due to social stressors associated with immigration. We assessed the associations of, and examined whether social stressors moderated associations between, alcohol use and alcohol-related consequences in a community-based sample of Latino immigrant men in Washington (N = 187). The mean Alcohol Use Disorders Identification Test Consumption (AUDIT-C) score was 6.3 (scores ≥ 4 indicate unhealthy alcohol use). More than half of the men (61.5%) reported experiencing discrimination in at least one setting and mean acculturative stress score was 18.3 indicating moderate levels of acculturative stress. Linear regression models were fit to assess main effects (associations between both alcohol use and social stressors and alcohol-related consequences) and moderation (whether the association between alcohol use and consequences varied based on experience of social stressors using multiplicative interaction) after adjustment for potential confounders. Alcohol use (β = 0.47, 95% CI = 0.20-0.73; p = .001), discrimination (β = 0.85, 95% CI = 0.27-1.43; p = .004), and acculturative stress (β = 0.13, 95% CI = 0.02-0.24; p = .025) were all associated with increased experience of alcohol-related consequences. The association between alcohol use and alcohol-related consequences was stronger for those with high levels of acculturative stress (p = .025) but not experience of discrimination (p = .587). Findings underscore the importance of social and cultural context in alcohol use and related consequences. Efforts to reduce negative consequences of drinking may include focus on reducing exposure to discrimination and acculturative stress.
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Affiliation(s)
- Vanessa N Torres
- University of California, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Emily C Williams
- University of Washington, Seattle, WA, USA
- Puget Sound Health Care System, Seattle, WA, USA
| | - Rachel M Ceballos
- University of Washington, Seattle, WA, USA
- Fred Hutchison Cancer Research Center, Seattle, WA, USA
| | - Dennis M Donovan
- University of Washington, Seattle, WA, USA
- Alcohol and Drug Abuse Institute (ADAI), Seattle, WA, USA
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28
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Hichborn EG, Moore SK, Gauthier PR, Agosti NO, Bell KD, Boggis JS, Lambert-Harris CA, Saunders EC, Turner AM, McLeman BM, Marsch LA. Technology-Based Interventions in Substance Use Treatment to Promote Health Equity Among People Who Identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native: Protocol for a Scoping Review. JMIR Res Protoc 2022; 11:e34508. [PMID: 35579930 PMCID: PMC9157317 DOI: 10.2196/34508] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/05/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Technology-based interventions (TBIs; ie, web-based and mobile interventions) have the potential to promote health equity in substance use treatment (SUTx) for underrepresented groups (people who identify as African American/Black, Hispanic/Latinx, and American Indian/Alaskan Native) by removing barriers and increasing access to culturally relevant effective treatments. However, technologies (emergent and more long-standing) may have unintended consequences that could perpetuate health care disparities among people who identify as a member of one of the underrepresented groups. Health care research, and SUTx research specifically, is infrequently conducted with people who identify with these groups as the main focus. Therefore, an improved understanding of the literature at the intersection of SUTx, TBIs, and underrepresented groups is warranted to avoid exacerbating inequities and to promote health equity. OBJECTIVE This study aims to explore peer-reviewed literature (January 2000-March 2021) that includes people who identify as a member of one of the underrepresented groups in SUTx research using TBIs. We further seek to explore whether this subset of research is race/ethnicity conscious (does the research consider members of underrepresented groups beyond their inclusion as study participants in the introduction, methods, results, or discussion). METHODS Five electronic databases (MEDLINE, Scopus, Cochrane Library, CINAHL, and PsycInfo) were searched to identify SUTx research using TBIs, and studies were screened for eligibility at the title/abstract and full-text levels. Studies were included if their sample comprised of people who identify as a member of one of the underrepresented groups at 50% or more when combined. RESULTS Title/abstract and full-text reviews were completed in 2021. These efforts netted a sample of 185 studies that appear to meet inclusionary criteria. Due to the uniqueness of tobacco relative to other substances in the SUTx space, as well as the large number of studies netted, we plan to separately publish a scoping review on tobacco-focused studies that meet all other criteria. Filtering for tobacco-focused studies (n=31) netted a final full-text sample for a main scoping review of 154 studies. The tobacco-focused scoping review manuscript is expected to be submitted for peer review in Spring 2022. The main scoping review data extraction and data validation to confirm the accuracy and consistency of data extraction across records was completed in March 2022. We expect to publish the main scoping review findings by the end of 2022. CONCLUSIONS Research is needed to increase our understanding of the range and nature of TBIs being used in SUTx research studies with members of underrepresented groups. The planned scoping review will highlight research at this intersection to promote health equity. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34508.
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Affiliation(s)
- Emily G Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Phoebe R Gauthier
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Nico O Agosti
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Kathleen D Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Jesse S Boggis
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Chantal A Lambert-Harris
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Avery M Turner
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Bethany M McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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29
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Cabrera Tineo YA, Dillon FR, Ertl MM, Rentería R, De La Rosa M. Discrimination-Based Acculturative Stress, Depression, and Alcohol Use among Latina Emerging Adults During Initial Months in the USA. Int J Ment Health Addict 2022; 20:553-568. [PMID: 35321450 PMCID: PMC8937027 DOI: 10.1007/s11469-020-00386-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background The present study examined the links between discrimination-based acculturative stress (DAS), depressive symptoms, and alcohol use among recently immigrated Latina young adults and explored potential within-group Latina ethnic differences. Methods Structural equation modeling was used to assess these relations among 530 Latina young adults (age 18-23) who had immigrated to the U.S. within approximately 12 months prior to assessment. Results Women reporting more DAS indicated more depressive symptoms and alcohol use than counterparts reporting less DAS. Women reporting more time in the U.S. experienced higher levels of DAS. Undocumented participants, and those who had lived in the U.S. for less time, reported more depressive symptoms than their peers. Discussion Findings highlight the need for mental health clinicians to attend to their local sociopolitical climate context for discriminatory practices and integrate cultural factors in mental health and alcohol use interventions targeting Latina young adults who recently immigrated to the U.S.
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Affiliation(s)
- Yajaira A. Cabrera Tineo
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY
| | - Frank R. Dillon
- Counseling & Counseling Psychology, Arizona State University, Tempe, AZ
| | - Melissa M. Ertl
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY
| | - Roberto Rentería
- Counseling & Counseling Psychology, Arizona State University, Tempe, AZ
| | - Mario De La Rosa
- Center for Research on U. S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL
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30
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Moyce S, Thompson S, Metcalf M, Velazquez M, Aghbashian E, Sisson N, Claudio D. Rural Hispanic Perceptions of Mental Health: A Qualitative Study. J Transcult Nurs 2022; 33:346-354. [PMID: 35075920 DOI: 10.1177/10436596211070592] [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] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2020, 18.4% of Hispanics experienced mental illness, yet only about a third received treatment compared with nearly half of non-Hispanic Whites. In Montana, where only 11% of the mental health needs are currently met, service utilization is low. The purpose of this study was to determine the perceptions of the Hispanic immigrant population in a rural state on mental health and professional service utilization. METHODS Using a descriptive phenomenological approach, we conducted semi-structured telephone interviews in Spanish. Audio recordings were transcribed, translated to English, and analyzed for themes. RESULTS We recruited a sample of 14 participants from Mexico, Ecuador, Colombia, and Venezuela ranging in age from 33 to 59. We identified five themes: definitions of mental health, maintaining mental health, familismo/socialization, stigma, and acculturation stress. DISCUSSION Novel findings point to the need for Spanish-language services focused on reducing stigma around mental illness and incorporating the importance of social connections.
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Sang J, Patton RA, Park I. Comparing Perceptions of Addiction Treatment between Professionals and Individuals in Recovery. Subst Use Misuse 2022; 57:983-994. [PMID: 35373710 DOI: 10.1080/10826084.2022.2058706] [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: 10/18/2022]
Abstract
Background: The purpose of this qualitative study was to compare and contrast the differing perspectives of service users and professionals regarding the current substance use disorders (SUD) services provided in Summit County, Ohio. Seven focus groups were conducted with 44 participants (52.3% male, mean age 46 years), including 15 individuals in recovery, 16 direct service providers, and 13 executive directors. The participants were asked about three areas: (1) effective treatment for SUD, (2) challenges for persons with SUD, and (3) suggestions for improving SUD treatment outcomes. The data were analyzed and coded according to major themes. Results: While there were numerous emergent themes that were concordant between service use and professionals, several differing themes between the groups were also identified. First, participants disagreed on the effectiveness of medication-assisted treatment/Medications for Opioid Use Disorder. Second, professionals identified trauma, stigma, "one-size-fits-all" approach to treatment, and limitations set by managed care act as barriers to treatment, whereas individuals in recovery reported difficulty dealing with feelings, feeling of being rushed into recovery, and the lack of long-term recovery plans as the most significant barriers. Lastly, in order to improve treatment outcomes, professionals emphasized the importance of education unlike individuals in recovery who identified sober supports as the most important factor. Conclusion: This study identified challenges in SUD recovery and highlights essential areas for consideration when developing and implementing SUD treatment. The findings can be used as guidelines to provide better services to individuals with SUDs.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2022.2058706 .
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Affiliation(s)
- Jina Sang
- School of Social Work and Family Sciences, The University of Akron, Akron, OH, USA
| | - Rikki A Patton
- School of Social Work and Family Sciences, The University of Akron, Akron, OH, USA
| | - Insun Park
- Department of Criminal Justice, The University of Akron, Akron, OH, USA
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32
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Tschampl CA, Canuto M, De Jesús D, D'Ippolito M, Guzman M, Larson MJ, Stewart E, Lundgren L. Adverse childhood experiences are associated with increased overdose risk in predominately Latinx adults seeking treatment for substance use disorders. Front Psychiatry 2022; 13:987085. [PMID: 36590627 PMCID: PMC9798211 DOI: 10.3389/fpsyt.2022.987085] [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] [Received: 07/05/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Almost no previous studies explored the relationship between adverse childhood experiences (ACEs) and overdose risk for individuals with substance use disorders (SUDs), and these did not focus on a Latinx population. This study examined the relationship between ACEs, reporting PTSD symptoms, and lifetime experience of overdose in a sample (n = 149) of primarily Latinx adults seeking treatment for substance use disorder (SUD). MATERIALS AND METHODS Administrative data from an integrated behavioral health and primary care treatment system in Massachusetts were analyzed through bivariate analyses and multiple logistic regression. The final model examined the association between self-reported ACEs, PTSD screen, and lifetime drug overdose. We controlled for demographic characteristics and heroin use and explored alternative measure specifications. RESULTS ACEs scores were high with 58% having experienced 4+ ACEs. Female gender was associated with a 24% higher ACE score than male gender (p < 0.01). In the multiple logistic model each additional ACE was associated with 1.3 times greater odds of overdose (p < 0.01). Those reporting heroin use had 8.8 times greater odds of reporting overdose compared to those reporting no heroin use (p < 0.001). Gender, age, Puerto Rican ethnicity, years of cocaine use, receiving public assistance income, and a positive initial PTSD screen were not significant. Findings were robust in sensitivity testing. DISCUSSION AND CONCLUSION We found the number of ACEs and reported heroin use significantly and positively associated with self-report of overdose in both bivariate and multiple logistic regression analyses. In contrast, a positive initial screen for PTSD was only significantly associated with overdose in the bivariate analysis. Increased screening for ACEs is warranted and ACE-specific treatment is suggested for SUD treatment programs offering trauma-informed services for adults.
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Affiliation(s)
- Cynthia A Tschampl
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | | | | | - Melinda D'Ippolito
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | | | - Mary Jo Larson
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | | | - Lena Lundgren
- Graduate School of Social Work, University of Denver, Denver, CO, United States
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Zemore SE, Ware OD, Gilbert PA, Pinedo M. Barriers to retention in substance use treatment: Validation of a new, theory-based scale. J Subst Abuse Treat 2021; 131:108422. [PMID: 34098296 PMCID: PMC8528875 DOI: 10.1016/j.jsat.2021.108422] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/01/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Few studies and no theory-based scales have addressed specific barriers to substance use disorder (SUD) treatment retention. The current study, building on the Theory of Planned Behavior (TPB), sought to (a) identify those barriers that are most strongly associated with treatment retention, and most common, and (b) develop and validate a new scale of retention barriers, focusing on TPB attitude and perceived control components. METHODS The study administered surveys to 200 participants initiating SUD treatment at a public, outpatient program in Northern California; the analytic sample (N = 156) included only those not strongly coerced into treatment. Surveys included TPB-based measures of treatment barriers; other motivational readiness measures; treatment coercion and social desirability measures; and clinical severity variables and demographics. Discharge status was collected from program records. RESULTS Item and scale analyses identified three dimensions of attitudinal barriers (i.e., Low Perceived Treatment Need/Value, Social Concerns, and Concerns about Missing Substances) and two dimensions of perceived control barriers (i.e., Personal Limitations and Basic Logistic Barriers). Results informed creation of a 19-item Barriers to Retention Scale (BRS) with 5 subscales and very good internal reliability (alpha = 0.88). While all subscale scores were correlated with treatment completion, only Concerns about Missing Substances and total BRS scores predicted treatment completion in multivariate analyses. CONCLUSIONS The present study identified core dimensions of treatment retention barriers and developed a new scale predictive of treatment completion and potentially useful as a screener and in future research. Results suggest that interventions to improve retention should focus strongly on concerns about the negative impacts of abstaining from alcohol and drugs on craving and quality of life.
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Affiliation(s)
- Sarah E Zemore
- Alcohol Research Group, Emeryville, CA, United States of America.
| | - Orrin D Ware
- School of Social Work, University of Maryland, Baltimore, MD, United States of America
| | - Paul A Gilbert
- Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, United States of America
| | - Miguel Pinedo
- Department of Kinesiology and Health Education, College of Education, University of Texas at Austin, TX, United States of America
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Venegas A, Donato S, Meredith LR, Ray LA. Understanding low treatment seeking rates for alcohol use disorder: A narrative review of the literature and opportunities for improvement. Am J Drug Alcohol Abuse 2021; 47:664-679. [PMID: 34464542 PMCID: PMC9059657 DOI: 10.1080/00952990.2021.1969658] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/16/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
Despite a well-documented global burden of disease attributable to alcohol use disorder (AUD), treatment seeking rates remain low. In this qualitative literature review, we address treatment seeking for AUD from a host of perspectives and summarize the literature on key factors. First, we summarize the rates of alcohol treatment seeking across various epidemiological surveys, spanning decades. Second, we discuss the definition of treatment seeking and 'what' is typically considered formal treatment. Third, we consider timing and discuss 'when' individuals are most likely to seek treatment. Fourth, we review the literature on 'who' is most likely to seek treatment, including demographic and clinical correlates. Fifth, we address the critical question of 'why' so few people receive clinical services for AUD, relative to the number of individuals affected by the disorder, and review barriers to treatment seeking at the treatment- and person-levels of analysis. Finally, we identify opportunities to improve treatment seeking rates by focusing on tangible points of intervention. Specifically, we recommend a host of adaptations to models of care including efforts to make treatment more appealing across stages of AUD severity, accept a range of health-enhancing drinking goals as opposed to an abstinence-only model, educate providers and consumers about evidence-based behavioral and pharmacological treatments, and incentivize the delivery of evidence-based services.
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Affiliation(s)
- Alexandra Venegas
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Suzanna Donato
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Lindsay R. Meredith
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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Pinedo M. Missed opportunities by health care providers to reduce racial/ethnic disparities in the use of alcohol treatment services. Drug Alcohol Depend 2021; 226:108851. [PMID: 34218007 PMCID: PMC10676020 DOI: 10.1016/j.drugalcdep.2021.108851] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objectives of this study were to: (1) investigate racial/ethnic differences in being offered information on alcohol treatment options by a health care provider; and (2) conduct stratified subgroup analyses to explore racial/ethnic differences in the use of alcohol treatment utilization among those who have received information on alcohol treatment services by a health care provider. METHODS Data from National Survey on Drug Use and Health (2015-2017) was used. Analyses were restricted to adult White, Black, and Latino participants who met diagnostic criteria for a past-year alcohol use disorder (AUD) and reported visiting a health care provider in the past-year (n = 4,939). A multivariable logistic regression model was estimated to investigate differences in being offered information on alcohol treatment by a health care provider by race/ethnicity. A sub analysis that was limited to participants who reported receiving information on alcohol treatment services by a health care provider (n = 481) was also conducted to explore racial/ethnic differences in treatment utilization. RESULTS Overall, health care providers rarely provided information on alcohol treatment services to persons with AUD. In multivariable analyses, Latinos were less likely to receive information on alcohol treatment services than Whites, but no White-Black differences were documented. When analyses were restricted to those who had received information on alcohol treatment options, no racial/ethnic differences in the use of alcohol treatment services were found. CONCLUSIONS Health care providers can potentially encourage use of alcohol treatment among those in need and contribute to reducing existing alcohol-related racial/ethnic disparities.
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Affiliation(s)
- Miguel Pinedo
- Department of Kinesiology & Health Education, College of Education, University of Texas, Austin, 2109 San Jacinto Blvd., Stop D3700, Austin, TX, 78712-1415, 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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Hai AH, Lee CS, Abbas BT, Bo A, Morgan H, Delva J. Culturally adapted evidence-based treatments for adults with substance use problems: A systematic review and meta-analysis. Drug Alcohol Depend 2021; 226:108856. [PMID: 34274617 DOI: 10.1016/j.drugalcdep.2021.108856] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This systematic review/meta-analysis aimed to synthesize empirical evidence from randomized controlled trials on the efficacy of culturally adapted interventions (CAIs) for substance use and related consequences for adults of color. METHODS Six electronic databases were searched to identify eligible studies. Two reviewers independently screened studies, extracted data, and assessed risks of bias. We used robust variance estimation in meta-regression to synthesize effect size estimates and conduct moderator analyses. RESULTS Twenty-two studies met the inclusion criteria and were included in the review. The overall effect size was 0.23 (95 % Confidence Interval [CI] = 0.12, 0.35). The subgroup effect sizes for comparing CAIs with inactive controls and with active controls were 0.31 (CI = 0.14, 0.48) and 0.14 (CI=-0.02, 0.29), respectively. The effect sizes for alcohol use, illicit drug use, unspecified substance use outcomes, and substance use related consequences were 0.25 (CI = 0.08, 0.43), 0.35 (CI =-0.30, 1.00), 0.22 (CI=-0.17, 0.62), and 0.02 (CI=-0.11, 0.16), respectively. Moderator analysis showed that CAIs' effects might not vary significantly by treatment model, dose, country, follow-up assessment timing, participant age, or gender/sex. CONCLUSIONS Research on substance use interventions that are culturally adapted for people of color is growing, and more high-quality studies are needed to draw definitive conclusions about CAIs' treatment effects. Our study found CAIs to be a promising approach for reducing substance use and related consequences. We call for more efficacy/effectiveness and implementation research to further advance the development and testing of evidence-based CAIs that meet the unique needs and sociocultural preferences of diverse populations.
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Affiliation(s)
- Audrey Hang Hai
- Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA.
| | - Christina S Lee
- Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA
| | - Bilal T Abbas
- Department of General Internal Medicine, Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Ai Bo
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E. Hartford Avenue, Milwaukee, WI, 53211, USA
| | - Henry Morgan
- Sociology Department, Vassar College, 124 Raymond Avenue, Poughkeepsie, NY, 12604, USA
| | - Jorge Delva
- Center for Innovation in Social Work & Health, School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA
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Simmons MM, Osilla KC, Miranda J, Paddock SM, McCullough CM. Understanding the characteristics of Latino individuals with first-time DUI offenses to facilitate effective interventions. J Ethn Subst Abuse 2021; 22:337-349. [PMID: 34365912 DOI: 10.1080/15332640.2021.1943096] [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] [Indexed: 10/20/2022]
Abstract
Literature shows that Latinos who drink are more likely to experience alcohol-related consequences and less likely to seek care for alcohol misuse than Whites. We aim to understand characteristics, consumption patterns, and openness to treatment among Latino first-time offenders driving under the influence. Latino participants were significantly younger (29.0 years) than non-Latinos (37.7 years). In adjusted models, Latino participants were significantly more likely than non-Latinos to binge drink, but there were no significant group differences in amount of alcohol consumed in a typical week. There was no significant difference in incidence of alcohol-related consequences, readiness to change drinking, and driving behaviors in this sample.
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Pinedo M, Zemore S, Beltrán-Girón J, Gilbert P, Castro Y. Women's Barriers to Specialty Substance Abuse Treatment: A Qualitative Exploration of Racial/Ethnic Differences. J Immigr Minor Health 2021; 22:653-660. [PMID: 31531756 DOI: 10.1007/s10903-019-00933-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Indexed: 01/05/2023]
Abstract
To explore barriers to specialty substance abuse treatment programs among women with recent substance use disorders by race/ethnicity. Qualitative interviews were conducted with 28 women of White, Black, and Latino racial/ethnic descent who reported a substance use disorder in the past 5 years. Interviews were conducted by telephone and were audio-recorded. A codebook was developed using the Theory of Planned Behavior to code and identify barriers within the domains of attitudes, subjective norms, and perceived control toward specialty treatment. Frequencies for coded themes were then compared across all participants and by race/ethnicity. We identified several key differences in barriers to treatment by race/ethnicity. Attitudinal barriers were more pervasive among the narratives of Latinas relative to Black and White women. Latinas were more likely to report not needing treatment and that treatment would not be effective; Latinas were the only group to describe cultural barriers to treatment. Within the subjective norms domain, namely stigma and lack of support, were key barriers. Stigma was more pervasive among the narratives of Latinas and Black women than White women; Latinas were more likely to report a lack of social support for using treatment than both Black and White women. Findings provide deeper insight into barriers that may be contributing to racial/ethnic disparities in the use of substance abuse treatment among women.
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Affiliation(s)
- M Pinedo
- Department of Kinesiology & Health Education, University of Texas, 2109 San Jacinto Blvd., Stop D3700, Austin, TX, 78712-1415, USA.
| | - S Zemore
- Alcohol Research Group, Emeryville, USA
| | - J Beltrán-Girón
- Teresa Lozano Long Institute of Latin American Studies, University of Texas, Austin, USA
| | - Paul Gilbert
- Department of Community & Behavioral Health, University of Iowa College of Public Health, Iowa City, USA
| | - Yessenia Castro
- Steve Hicks School of Social Work, University of Texas, Austin, USA
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Abstract
Mutual help groups are a ubiquitous component of the substance abuse treatment system in the United States, showing demonstrated effectiveness as a treatment adjunct; so, it is paramount to understand whether they are as appealing to, and as effective for, racial or ethnic minority groups as they are for Whites. Nonetheless, no known comprehensive reviews have examined whether there are racial/ethnic disparities in mutual help group participation. Accordingly, this study comprehensively reviewed the U.S. literature on racial/ethnic disparities in mutual help participation among adults and adolescents with substance use disorder treatment need. The study identified 19 articles comparing mutual help participation across specific racial/ethnic minority groups and Whites, including eight national epidemiological studies and 11 treatment/community studies. Most compared Latinx and/or Black adults to White adults, and all but two analyzed 12-step participation, with others examining "self-help" attendance. Across studies, racial/ethnic comparisons yielded mostly null (N = 17) and mixed (N = 9) effects, though some findings were consistent with a racial/ethnic disparity (N = 6) or minority advantage (N = 3). Findings were weakly suggestive of disparities for Latinx populations (especially immigrants, women, and adolescents) as well as for Black women and adolescents. Overall, data were sparse, inconsistent, and dated, highlighting the need for additional studies in this area.
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Affiliation(s)
| | - Paul A Gilbert
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa
| | - Miguel Pinedo
- Center for Health and Social Policy, College of Education-Kinesiology and Health Education, University of Texas, Austin, Texas
| | - Shiori Tsutsumi
- School of Environment and Society, Department of Social and Human Sciences, Tokyo Institute of Technology, Tokyo, Japan
| | - Briana McGeough
- Cofrin Logan Center for Addiction Research and Treatment, School of Social Welfare, University of Kansas, Lawrence, Kansas
| | - Daniel L Dickerson
- Integrated Substance Abuse Programs, University of California, Los Angeles, California
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Sanchez K, Gryczynski J, Carswell SB, Schwartz RP. Development and Feasibility of a Spanish Language Version of the Tobacco, Alcohol, Prescription Drug, and Illicit Substance Use (TAPS) Tool. J Addict Med 2021; 15:61-67. [PMID: 32657958 DOI: 10.1097/adm.0000000000000699] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Tobacco, Alcohol, Prescription drug, and illicit Substance use (TAPS) Tool is a validated two-stage screening and brief assessment in primary care for unhealthy substance use. We developed a Spanish language version of the TAPS Tool and conducted a small study of its feasibility, acceptability, and preliminary validity. METHODS Participants were adult primary care patients ages 18 or older with Spanish as their primary language (N = 10 for development/refinement using qualitative congnitive interviewing; N = 100 for the preliminary validation study). The Spanish language TAPS Tool was administered in both interviewer- and selfadministered tablet format (in random order). We examined disclosure of substance use on the TAPS by administration format, and compared it with established measures for identifying substance use and substance use disorders. RESULTS The Spanish language TAPS was feasible to use and participants reported high levels of acceptability. The rates of past 12-month substance use were 11% for tobacco, 28% for risky alcohol, 4% for illicit drugs, 1% for nonmedical prescription drugs and substance use disorders rates were 7% for tobacco, 2% for alcohol, and 1% for other substances. The selfadministered TAPS elicited 1, 3, and 1 additional disclosures of tobacco, risky, alcohol, and marijuana use than the interviewer-administered TAPS, respectively. Rates of disclosure on the TAPS were similar to those on established measures for past 12-month and 3-month time frames. CONCLUSIONS The current study represents a starting point for expanding the availability of the TAPS Tool beyond its original English language version into Spanish. The Spanish language TAPS Tool could expand options for substance use screening in primary care settings with Spanish-dominant/preferred populations. TRIAL REGISTRATION The studies were registered with www.clinicaltrials.gov: NCT03879785, March 19, 2019.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, TX (KS); Friends Research Institute, Baltimore, MD (JG, SBC, RPS); COG Analytics, Potomac, MD
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López-Tamayo R, Jason LA. THE ASSOCIATION BETWEEN BEHAVIORAL AND ATTITUDINAL ACCULTURATION ON LATINX IMMIGRANTS AND U.S.-BORN LATINXS: A MULTIDIMENSIONAL ACCULTURATION MODEL. Community Psychol Glob Perspect 2021; 7:81-102. [PMID: 36457550 PMCID: PMC9710741 DOI: 10.1285/i24212113v7i2p81] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Disparities in access and utilization of substance abuse treatment (SAT) among Latinxs, accentuated by this population's rapid growth, create a public health issue. Although substance abuse literature has given more consideration to environmental factors and social support concerning treatment outcomes, current substance abuse models fail to address important contextual and cultural aspects for Latinxs in recovery, including acculturation. The proposed study aims to test out a multidimensional acculturation model on a sample of 131 Latinxs (Mage= 36.3; SD±10.4, 117 males, 49% immigrants) who recently completed SAT. Specifically, the proposed study employed a conditional process model using the PROCESS Macro for SPSS to examine the association between behavioral acculturation and substance use behavior in the past six months on nativity status at different levels of attitudinal acculturation. Results yielded that, after controlling for age and substance use, higher endorsement of U.S. mainstream cultural practices was associated with a higher frequency of days using alcohol among Latinx immigrants, specifically those reporting high and very high affiliation to the U.S. mainstream culture. Also, a negative association between U.S. mainland-born Latinx and frequency of days using illicit drugs in the past six months was observed, but only among those who endorse very high affiliation of U.S. mainstream culture.
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Affiliation(s)
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, USA
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Almanza-Avendaño AM, Romero Mendoza M, Gomez-San Luis AH. "I Didn't See It as a Problem, I Thought It Was Going to Be Taken Away": Narratives From Family Members of Users in Rehab. Front Psychiatry 2021; 12:649961. [PMID: 34483979 PMCID: PMC8416069 DOI: 10.3389/fpsyt.2021.649961] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
There are multiple discourses on addictions that influence the way in which relatives interpret the substance use of a family member. The purpose of this study is to understand the influence of these discourses on the construction of use as a problem by relatives of people in recovery. Narratives were obtained on the path of the illness to identify the phases in the construction of use as a problem and the influence of the discourses on each phase. The process has four successive phases: normalization, impasse, exasperation, and adoption of the treatment ideology. This process goes from the legitimization of use to its moral interpretation and subsequently to the transition to medical discourse. It is concluded that it is important to reduce the influence of the moral discourse in order to facilitate timely detection and early care, as well as to design interventions focused on the reconstruction of use as a problem.
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Affiliation(s)
| | - Martha Romero Mendoza
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría, Ciudad de México, Mexico City, Mexico
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Abstract
Special emphasis populations in the current context can be defined as groups experiencing health disparities resulting in elevated risk to health, safety, and well-being from drinking alcohol. Individuals from marginalized minority populations often encounter barriers to accessing and receiving effective alcohol treatment due to social inequities and disadvantaged life contexts, which also may adversely affect recovery from alcohol use disorder (AUD). Recovery from AUD often involves the adoption of a stable non-drinking lifestyle (sobriety), increased health and well-being, and increased social connection. Although there has been considerable work on AUD epidemiology among special emphasis populations, little research exists directly examining recovery among racial/ethnic minority populations and/or sexual and gender minority populations. The current narrative review hopes to spark scholarly interest in this critically neglected area. This article opens with a review of special emphasis populations and their alcohol-related risks. Next, definitions of recovery, Alcoholics Anonymous, and culturally adapted recovery models for racial/ethnic minority populations are explored. This is followed by a discussion of factors that may particularly influence recovery among marginalized minority populations. This narrative review concludes with a discussion of research priorities for promoting health equity through studies focused on understanding and supporting recovery from AUD among marginalized minority populations.
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Affiliation(s)
- Eric F Wagner
- Robert Stempel College of Public Health & Social Work, Community-Based Research Institute, and National Institute on Minority Health and Health Disparities (NIMHD) Research Center in a Minority Institution (RCMI), Florida International University, Miami, Florida
| | - Julie A Baldwin
- Center for Health Equity Research and NIMHD RCMI Southwest Health Equity Research Collaborative, Northern Arizona University, Flagstaff, Arizona
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Kour P, Lien L, Kumar B, Biong S, Pettersen H. Treatment Experiences with Norwegian Health Care among Immigrant Men Living with Co-Occurring Substance Use- and Mental Health Disorders. Subst Abuse 2020; 14:1178221820970929. [PMID: 33281448 PMCID: PMC7691914 DOI: 10.1177/1178221820970929] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022]
Abstract
Immigrants are considered at risk of psychological distress and therefore
involvement in substance abuse, due to a variety of pre- and post-migration
factors. Further, there is lower treatment engagement, a higher dropout rate,
and less frequent hospitalizations among this group compared to the general
population. There are few studies on the subjective understanding of
co-occurring substance use disorder (SUD) and mental health disorder (MHD) among
immigrants in Norway. This qualitative study aims to explore the treatment
experiences of immigrant men living with co-occurring SUD and MHD. Within a
collaborative approach, individual interviews were conducted with 10 men of
immigrant background, living with co-occurring SUD and MHD, who had treatment
experiences from the Norwegian mental health and addiction services. Data were
analyzed using a systematic text condensation. The analysis yielded 6 categories
where participants described their treatment experiences in mental health and
addiction services in Norway as: lack of connection, lack of individually
tailored treatment, stigma and discrimination preventing access to treatment,
health professionals with multi-cultural competence, care during and after
treatment, and raising awareness and reducing stigma. A significant finding was
the mention by participants of the value of being seen and treated as a “person”
rather than their diagnosis, which may increase treatment engagement. They
further mentioned aftercare as an important factor to prevent relapse. This
study provides an enhanced understanding of how immigrant men living with
co-occurring SUD and MHD experienced being treated in Norwegian healthcare
settings. These experiences may add to the knowledge required to improve
treatment engagement.
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Affiliation(s)
- Prabhjot Kour
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders (NK-ROP), Innlandet Hospital Trust and University of South-Eastern Norway, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders (NK-ROP) Innlandet Hospital Trust; and Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Norway
| | | | - Stian Biong
- University of South-Eastern Norway, Kongsberg, Norway
| | - Henning Pettersen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders (NK-ROP) Innlandet Hospital Trust; and Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Norway
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Bensley KMK, Karriker-Jaffe KJ, Cherpitel C, Li L, Wallisch LS, Zemore SE. Limited treatment accessibility: Implications for alcohol treatment disparities among Mexican Americans living in the U.S.-Mexico border region. J Subst Abuse Treat 2020; 121:108162. [PMID: 33172725 DOI: 10.1016/j.jsat.2020.108162] [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] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 09/12/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Receipt of alcohol-related care for alcohol use is particularly low among those residing in the U.S.-Mexico border region. One reason for this disparity may be limited treatment accessibility, making it difficult for those who need it to access needed treatment. The current study assesses whether differences in treatment utilization are mediated by differences in treatment accessibility in cities within and outside of the border region. METHODS We used data from the U.S.-Mexico Study of Alcohol and Related Conditions involving a probability sample of Mexican-origin adults surveyed in three cities in Texas (2011-2013). We included only participants with a lifetime history of alcohol use disorder (AUD) (n = 792). We examined two lifetime measures of self-reported alcohol treatment utilization: considering getting help for an alcohol problem and receipt of treatment. We geocoded locations of facilities listed in the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities. We considered three types of facilities: any outpatient treatment, programs offering fee assistance, and programs offering Spanish-language services. We measured treatment accessibility by density of treatment (i.e., number of facilities within a 20-mile radius of participant's residence) and proximity to treatment (i.e., travel time to nearest facility). We assessed direct and indirect effects of two cities in the border region (versus one nonborder city) on the outcomes through treatment accessibility using generalized structural equation models that accounted for clustering of respondents in cities and in neighborhoods, weighted for sampling and nonresponse and adjusted for covariates. RESULTS Of 792 respondents with lifetime AUD, 22% had considered getting help and 11% had received treatment, with consideration of getting help being less likely in cities in the border region. We observed no significant differences in treatment receipt across cities. Reduced densities of all three types of treatment programs were significant mediators for the effect of residing in a border region on considering getting help. Time to nearest Spanish-language program also mediated the effect of residing in a border region on considering getting help for one city. CONCLUSIONS Border cities had lower density of treatment and because treatment density was positively associated with considering getting help, residence in a city in the border region was associated with lower odds of considering getting help, regardless of type of treatment. These findings suggest increasing the number of treatment locations available within cities along the U.S.-Mexico border may encourage those with AUD to consider getting help.
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Affiliation(s)
- Kara M K Bensley
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St #450, Emeryville, CA 94062, USA; University of California, Berkeley School of Public Health, 6001 Shellmound St #450, Emeryville, CA 94062, USA.
| | | | - Cheryl Cherpitel
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St #450, Emeryville, CA 94062, USA.
| | - Libo Li
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St #450, Emeryville, CA 94062, USA.
| | - Lynn S Wallisch
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd., Austin, TX 78712, USA.
| | - Sarah E Zemore
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St #450, Emeryville, CA 94062, USA; University of California, Berkeley School of Public Health, 6001 Shellmound St #450, Emeryville, CA 94062, USA.
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Pinedo M, Villatoro AP. The role of perceived treatment need in explaining racial/ethnic disparities in the use of substance abuse treatment services. J Subst Abuse Treat 2020; 118:108105. [PMID: 32839050 DOI: 10.1016/j.jsat.2020.108105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/27/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The current study examined the role of perceived treatment need in explaining racial/ethnic disparities in treatment utilization for a substance use disorder (SUD). METHODS We pooled data from the National Survey on Drug Use and Health survey for years 2014-2017. The analytic sample included adult white, Black, and Latino participants with a past-year SUD (n = 16,393). Multivariable logistic regressions examined racial/ethnic disparities in perceived treatment need-the perception of needing mental health and/or SUD treatment services within the past 12 months-and utilization of past-year substance use, mental health, and any treatment. RESULTS Latinos with SUD were less likely to perceive a need for treatment than whites. Black and Latino participants, relative to white participants, had lower odds of past-year treatment utilization, regardless of treatment type. In models stratified by perceived treatment need, racial/ethnic differences in the use of past-year SUD treatment and any treatment service were only significant among persons without a perceived need for treatment. We found no disparities in use of mental health treatment. CONCLUSIONS Adults with SUD have low perceived treatment need overall but especially among Latinos. Furthermore, Black and Latino disparities in SUD treatment use may be driven in part by lower perceived need for treatment. Interventions that promote better perceived need and delivery models that strengthen the integration of SUD treatment in mental health services may help to reduce these disparities.
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Affiliation(s)
- M Pinedo
- Department of Kinesiology & Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd., Stop D3700, Austin, TX 78712-1415, United States of America.
| | - A P Villatoro
- Latino Research Institute, The University of Texas at Austin, 210 W. 24th Street, Stop F9200, Austin, TX 78712, United States of America
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Mauro PM, Samples H, Klein KS, Martins SS. Discussing Drug Use With Health Care Providers Is Associated With Perceived Need and Receipt of Drug Treatment Among Adults in the United States: We Need to Talk. Med Care 2020; 58:617-624. [PMID: 32520836 PMCID: PMC8112806 DOI: 10.1097/mlr.0000000000001340] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Drug treatment utilization is low despite a high public health burden of drug use disorders (DUDs). Engaging people at risk for DUDs across a broader range of health care settings may improve uptake of drug treatment. OBJECTIVES To estimate the prevalence of drug use screening/discussions between health care providers and individuals with past-year drug use, and to assess the associations between drug use screening/discussions and perceived need and use of drug treatment. METHODS We analyzed representative cross-sectional data from the 2015 to 2017 National Surveys on Drug Use and Health. The sample included adults aged 18 years and above reporting past-year drug use and ≥1 health care visit. We measured correlates of drug use screening/discussions using multinomial logistic regression. Overall and among adults meeting DUD criteria, we used logistic regression to estimate associations between drug use screening/discussions and (1) past-year drug treatment and (2) perceived need for treatment. RESULTS In the full sample (n=21,505), 34.50% reported no screening/discussions, 44.50% reported screening only, and 21.00% reported discussions with providers. Discussions were associated with significantly higher odds of receiving any drug treatment [adjusted odds ratio (aOR)=3.52 (2.66-4.65)], specialty drug treatment [aOR=4.13 (2.92-5.82)], and perceived treatment need [aOR=2.08 (1.21-3.59)]. Among people with DUD (n=3,834; 15.69%), discussions were associated with treatment use, but not with perceived need. CONCLUSIONS Discussing drug use with providers may impact people's perceptions of drug treatment need and use, indicating potential opportunities to engage people in addiction treatment. Addressing barriers to discussing drug use across care settings could increase treatment use, particularly among people with DUD.
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Affiliation(s)
- Pia M. Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York NY, USA
| | - Hillary Samples
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York NY, USA
| | - Kathryn S. Klein
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York NY, USA
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York NY, USA
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Eghaneyan BH, Sanchez K, Haeny AM, Montgomery L, Lopez-Castro T, Burlew AK, Rezaeizadeh A, Killian MO. Hispanic participants in the National Institute on Drug Abuse's Clinical Trials Network: A scoping review of two decades of research. Addict Behav Rep 2020; 12:100287. [PMID: 32637563 PMCID: PMC7330873 DOI: 10.1016/j.abrep.2020.100287] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/10/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023] Open
Abstract
Hispanics experience multiple structural barriers to adequate substance use treatment. Effective interventions for Hispanic populations exist. Measurement equivalence and culturally-tailored programs are essential.
Introduction Hispanics significantly underutilize substance abuse treatment and are at greater risk for poor treatment outcomes and dropout. Two decades of research from the National Drug Abuse Treatment Clinical Trials Network (CTN) offers an opportunity to increase our understanding in how to address the disparities experienced by Hispanics in substance abuse treatment. Methods A scoping review was utilized to determine what has been learned from the CTN about Hispanic populations with substance use disorder. A systematic search was conducted within the CTN Dissemination Library and nine databases. Potentially relevant studies were independently assessed by two reviewers for inclusion. Results Twenty-four studies were included in the review. Results identified issues in measurement, characteristics of Hispanic substance use, effective interventions, and gaps for future research. Characteristics that interfere with treatment participation were also identified including low employment rates, less likelihood of having insurance, lower rates of internet access, and increased travel time to services, as were treatment issues such as high rates of alcohol and tobacco use. Effective interventions were identified; however, the effectiveness of these interventions may be limited to specific factors. Conclusions Despite efforts to improve inclusion of minority populations, Hispanics remain underrepresented in clinical trials. Future research including Hispanic populations should examine measurement equivalence and consider how cultural and historical experiences, as well as patient characteristics, influence utilization of services. Finally, more studies are needed that examine the impact of structural factors that act as barriers to treatment access and engagement and result in significant disparities in treatment outcomes.
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Affiliation(s)
- Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX 76019, United States
| | - Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Box 19129, Arlington, TX 76019, United States.,Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Angela M Haeny
- Yale School of Medicine, 34 Park St., New Haven, CT 06519, United States
| | - LaTrice Montgomery
- Center for Addiction Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 204, Cincinnati, Ohio 45221, United States
| | - Teresa Lopez-Castro
- The City College of New York, 160 Convent Ave., New York, NY 10031, United States
| | - A Kathleen Burlew
- University of Cincinnati, 2600 Clifton Ave., Cincinnati, OH 45220, United States
| | - Afsaneh Rezaeizadeh
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Michael O Killian
- College of Social Work, Florida State University, 296 Champions Way, UCC 3407, Tallahassee, FL 32309, United States
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Schiff DM, Nielsen T, Hoeppner BB, Terplan M, Hansen H, Bernson D, Diop H, Bharel M, Krans EE, Selk S, Kelly JF, Wilens TE, Taveras EM. Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts. JAMA Netw Open 2020; 3:e205734. [PMID: 32453384 PMCID: PMC7251447 DOI: 10.1001/jamanetworkopen.2020.5734] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Racial and ethnic disparities persist across key health and substance use treatment outcomes for mothers and infants. The use of medications, such as methadone or buprenorphine, for the treatment of opioid use disorder (OUD) has been associated with improvements in the outcomes of mothers and infants; however, only half of all pregnant women with OUD receive these medications. The extent to which maternal race or ethnicity is associated with the use of medication to treat OUD, the duration of the use of medication to treat OUD, and the type of medication used to treat OUD during pregnancy are unknown. OBJECTIVE To examine the extent to which maternal race and ethnicity is associated with the use of medications for the treatment of OUD in the year before delivery among pregnant women with OUD. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used a linked population-level statewide data set of pregnant women with OUD who delivered a live infant in Massachusetts between October 1, 2011, and December 31, 2015. Of 274 234 total deliveries identified, 5247 deliveries among women with indicators of having OUD were included in the analysis. Maternal race and ethnicity were defined as white non-Hispanic, black non-Hispanic, or Hispanic based on self-reported data on birth certificates. MAIN OUTCOMES AND MEASURES Main outcomes were the receipt of any medication for OUD, the consistency of the use of medication (at least 6 continuous months of use before delivery, inconsistent use, or no use) for the treatment of OUD, and the type of medication (methadone or buprenorphine) used to treat OUD. Multivariable models were adjusted for maternal sociodemographic characteristics, comorbidities, and any significant interactions between the covariates and race and ethnicity. RESULTS The sample included 5247 pregnant women with OUD who delivered a live infant in Massachusetts during the study period. The mean (SD) maternal age at delivery was 28.7 (5.0) years; 4551 women (86.7%) were white non-Hispanic, 462 women (8.8%) were Hispanic, and 234 women (4.5%) were black non-Hispanic. A total of 3181 white non-Hispanic women (69.9%) received any type of medication for the treatment of OUD in the year before delivery compared with 228 Hispanic women (49.4%) and 108 black non-Hispanic women (46.2%). Compared with white non-Hispanic women, black non-Hispanic and Hispanic women had a substantially lower likelihood (adjusted odds ratio [aOR], 0.37; 95% CI, 0.28-0.49 and aOR, 0.42; 95% CI, 0.35-0.52, respectively) of receiving any medication for the treatment of OUD. Stratification by maternal age identified greater disparities among younger women. Black non-Hispanic and Hispanic women also had a lower likelihood (aOR, 0.24; 95% CI, 0.17-0.35 and aOR, 0.34; 95% CI, 0.27-0.44, respectively) of consistent use of medication for the treatment of OUD compared with white non-Hispanic women. With respect to the type of medication used to treat OUD, black non-Hispanic and Hispanic women had a lower likelihood (aOR, 0.60; 95% CI, 0.40-0.90 and aOR, 0.77; 95% CI, 0.58-1.01, respectively) than white non-Hispanic women of receiving buprenorphine treatment compared with methadone treatment. CONCLUSIONS AND RELEVANCE This study found racial and ethnic disparities in the use of medications to treat OUD during pregnancy, with black non-Hispanic and Hispanic women significantly less likely to use medications consistently or at all compared with white non-Hispanic women. Further investigation of patient, clinician, treatment program, and system-level factors associated with these findings is warranted.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Timothy Nielsen
- Child Population and Translational Health Research, University of Sydney, Randwick, New South Wales, Australia
| | | | | | - Helena Hansen
- Department of Psychiatry, New York University, New York, New York
| | - Dana Bernson
- Massachusetts Department of Public Health, Boston
| | | | | | - Elizabeth E. Krans
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Women’s Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sabrina Selk
- Massachusetts Department of Public Health, Boston
| | - John F. Kelly
- Department of Psychiatry, New York University, New York, New York
| | - Timothy E. Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
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