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Van Doren N, Ng H, Rawat E, McKenna KR, Blonigen DM. Virtual reality mindfulness training for veterans in residential substance use treatment: Pilot study of feasibility and acceptability. J Subst Use Addict Treat 2024; 161:209315. [PMID: 38378078 DOI: 10.1016/j.josat.2024.209315] [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] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/12/2024] [Accepted: 02/11/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Mindfulness training is effective in recovery from substance use disorders; however, adoption can be difficult due to environmental and personal distractions. Virtual reality (VR) may help overcome these challenges by providing an immersive environment for practicing mindfulness, but there is currently limited knowledge regarding patient and provider perceptions of VR-based tools. OBJECTIVE The present study investigated the feasibility and acceptability of VR mindfulness training for veterans in residential substance use treatment as well as potential benefits of VR mindfulness interventions in this population. We conducted a pilot feasibility/acceptability study as a first step toward conducting a larger randomized controlled trial (RCT). METHODS The study recruited participants (N = 32) from a 30-day residential substance use program and collected both qualitative and quantitative feedback on the VR mindfulness intervention using a mixed-methods approach. Patients (n = 20) and providers (n = 12) rated the acceptability, usability, and satisfaction of the intervention. Using a within-subjects design, patients provided pre-post emotion ratings and reported on state mindfulness and VR presence after completing a single-session self-guided VR mindfulness intervention. Patients provided qualitative interview data on their overall impressions, while providers gave the same information via survey. RESULTS Both patients and providers reported high satisfaction and confidence in the intervention. Moreover, within subjects t-tests showed that patients experienced significant reductions in negative affect and significant increases in positive affect from pre-post, along with high levels of state mindfulness and presence. Results of thematic analysis revealed that the intervention facilitated focused attention on the present moment, induced a state of calm and relaxation, and reduced negative thoughts and emotions. Participants requested improvements such as better integration of audiovisual elements, a more personalized and longer intervention, and more comfortable fitting headset. Finally, the intervention presented with several advantages compared to other mindfulness experiences including reduced distractions and a sense of safety and privacy. CONCLUSIONS Self-guided VR mindfulness intervention is feasible and acceptable to patients and providers. VR mindfulness training provides an immersive experience that uplifts mood and reduces distractions. VR may provide a scaffolding tool to set the stage for deepening mindfulness skills. Results of the present study could inform further development and tailoring for future interventions.
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Affiliation(s)
- Natalia Van Doren
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States of America.
| | - Helen Ng
- Department of Psychology, University of California, Berkeley, CA, United States of America
| | - Eshaan Rawat
- Department of Engineering, Stanford University, Stanford, CA, United States of America
| | - Kevin R McKenna
- VA Palo Alto Healthcare System, Department of Veterans Affairs, Palo Alto, CA, United States of America
| | - Daniel M Blonigen
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
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Lazic A, Tilford JM, Davis VP, Brown CC. Association of copayments with healthcare utilization and expenditures among Medicaid enrollees with a substance use disorder. J Subst Use Addict Treat 2024; 161:209314. [PMID: 38369244 PMCID: PMC11090739 DOI: 10.1016/j.josat.2024.209314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/04/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The purpose of this study was to examine the association between copayments and healthcare utilization and expenditures among Medicaid enrollees with substance use disorders. METHODS This study used claims data (2020-2021) from a private insurer participating in Arkansas's Medicaid expansion. We compared service utilization and expenditures for enrollees in different Medicaid program structures with varying copayments. Enrollees with incomes above 100 % FPL (N = 10,240) had copayments for substance use treatment services while enrollees below 100 % FPL (N = 2478) did not. Demographic, diagnostic, utilization, and cost information came from claims and enrollment information. The study identified substance use and clinical comorbidities using claims from July through December 2020 and evaluated utilization and costs in 2021. Generalized linear models (GLM) estimated outcomes using single equation and two-part modeling. A gamma distribution and log link were used to model expenditures, and negative binomial models were used to model utilization. A falsification test comparing behavioral health telemedicine utilization, which had no cost sharing in either group, assessed whether differences in the groups may be responsible for observed findings. RESULTS Substance use enrollees with copayments were less likely to have a substance use or behavioral health outpatient (-0.04 PP adjusted; p = 0.001) or inpatient visit (-0.04 PP; p = 0.001) relative to their counterparts without copayments, equal to a 17 % reduction in substance use or behavioral health outpatient services and a nearly 50 % reduction in inpatient visits. The reduced utilization among enrollees with a copayment was associated with a significant reduction in total expenses ($954; p = 0.001) and expenses related to substance use or behavioral health services ($532; p = 0.001). For enrollees with at least one behavioral health visit, there were no differences in outpatient or inpatient utilization or expenditures between enrollees with and without copayments. Copayments had no association with non-behavioral health or telemedicine services where neither group had cost sharing. CONCLUSION Copayments serve as an initial barrier to substance use treatment, but are not associated with the amount of healthcare utilization conditional on using services. Policy makers and insurers should consider the role of copayments for treatment services among enrollees with substance use disorders in Medicaid programs.
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Affiliation(s)
- Antonije Lazic
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
| | - J Mick Tilford
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
| | - Victor P Davis
- Actuarial Services & Enterprise Underwriting, Arkansas Blue Cross Blue Shield, Little Rock, AR 72201, USA
| | - Clare C Brown
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA.
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Ahrens J, Zaher F, Rabin RA, Cassidy CM, Palaniyappan L. Neuromelanin levels in individuals with substance use disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 161:105690. [PMID: 38678736 DOI: 10.1016/j.neubiorev.2024.105690] [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: 12/15/2023] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
Dopamine's role in addiction has been extensively studied, revealing disruptions in its functioning throughout all addiction stages. Neuromelanin in the substantia nigra (SN) may reflect dopamine auto-oxidation, and can be quantified using neuromelaninsensitive magnetic resonance imaging (neuromelanin-MRI) in a non-invasive manner.In this pre-registered systematic review, we assess the current body of evidence related to neuromelanin levels in substance use disorders, using both post-mortem and MRI examinations. The systematic search identified 10 relevant articles, primarily focusing on the substantia nigra. An early-stage meta-analysis (n = 6) revealed varied observations ranging from standardized mean differences of -3.55 to +0.62, with a pooled estimate of -0.44 (95 % CI = -1.52, 0.65), but there was insufficient power to detect differences in neuromelanin content among individuals with substance use disorders. Our gap analysis highlights the lack of sufficient replication studies, with existing studies lacking the power to detect a true difference, and a complete lack of neuromelanin studies on certain substances of clinical interest. We provide recommendations for future studies of dopaminergic neurobiology in addictions and related psychiatric comorbidities.
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Affiliation(s)
- Jessica Ahrens
- Douglas Research Centre, Douglas Mental Health Research Institute, Montreal, Quebec, Canada; Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Farida Zaher
- Douglas Research Centre, Douglas Mental Health Research Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Rachel A Rabin
- Douglas Research Centre, Douglas Mental Health Research Institute, Montreal, Quebec, Canada; Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Clifford M Cassidy
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Lena Palaniyappan
- Douglas Research Centre, Douglas Mental Health Research Institute, Montreal, Quebec, Canada; Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.
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Giang LM, Trang NT, Hoe HD, Anh NH, Thuy DTT, Bart G. "If they get out of drug rehab centers, they're on their own": Opportunities and challenges for people released from compulsory drug rehabilitation centers to communities in Vietnam. Int J Drug Policy 2024; 128:104443. [PMID: 38743963 DOI: 10.1016/j.drugpo.2024.104443] [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: 12/20/2023] [Revised: 04/21/2024] [Accepted: 04/21/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Compulsory drug rehabilitation is a major governmental response to illicit drug use in Vietnam and other countries in Asia. Long-term compulsory rehabilitation is associated with negative health, social and economic outcomes. The transition to community-based services for people released from compulsory drug rehabilitation has been problematic not only in Vietnam. This study utilized the WHO Health System Building Blocks Framework to examine the opportunities and challenges for people with substance use disorders (SUD) who are released from compulsory drug rehabilitation back into the community. METHODS Between October 2021 and August 2022, we interviewed people with SUD who had recently returned from or were preparing to leave compulsory drug rehabilitation (n = 25), their family members (n = 20) and professionals working in the field of drug rehabilitation (n = 28) across three cities in Vietnam. Additionally, we conducted a review of policy documents to complement the interview data. RESULTS The study identified opportunities and challenges within Vietnam's drug rehabilitation system concerning leadership and governance, financing, workforce, information systems and service delivery for people with SUD. Key opportunities include a legal framework that emphasizes community-based support for people with SUD, a government-funded national network of lay social workers, and ongoing efforts to connect people to community-based services. We found significant challenges caused by the lack of clear instructions for implementing supportive policies, inadequate funding for community-based services, persisting stigma from providers towards people with SUD and unavailability of community-based drug treatment other than methadone. CONCLUSION Vietnam continues with compulsory drug rehabilitation yet endorses recovery-oriented policies to address substance use issues. Substantial challenges hinder the effective implementation of these policies. Our study recommends reinforcing existing policies and enhancing recovery-oriented community-based services by improving the quality of data collection, building capacity of lay social workers who facilitate linkages to services and expanding community-based drug treatment options.
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Affiliation(s)
- Le Minh Giang
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Vietnam
| | - Nguyen Thu Trang
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Vietnam.
| | - Han Dinh Hoe
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Vietnam
| | - Nguyen Huu Anh
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Vietnam
| | - Dinh Thi Thanh Thuy
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Vietnam
| | - Gavin Bart
- Division of Addiction Medicine, Hennepin Healthcare and University of Minnesota Medical School, United States
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Swinford-Jackson SE, Pierce RC. Deep brain stimulation for psychostimulant use disorders. J Neural Transm (Vienna) 2024; 131:469-473. [PMID: 37823965 DOI: 10.1007/s00702-023-02706-6] [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: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
Safe and effective therapeutics for psychostimulant use disorders remain elusive. Deep brain stimulation (DBS), which is FDA-approved for other indications, is a promising candidate for treating severe substance use disorders. We examine the clinical and preclinical evidence for DBS of the nucleus accumbens as a possible therapeutic option for cocaine and methamphetamine use disorders. Limitations of the literature to date, including the lack of females included in studies evaluating the efficacy of DBS, and new strategies to optimize brain stimulation approaches are also discussed.
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Affiliation(s)
- Sarah E Swinford-Jackson
- Brain Health Institute and Department of Psychiatry, Rutgers University, 683 Hoes Lane West Room 160, Piscataway, NJ, 08854-5635, USA.
| | - R Christopher Pierce
- Brain Health Institute and Department of Psychiatry, Rutgers University, 683 Hoes Lane West Room 160, Piscataway, NJ, 08854-5635, USA
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Kamiński P, Lorek M, Baszyński J, Tadrowski T, Gorzelańczyk EJ, Feit J, Tkaczenko H, Owoc J, Woźniak A, Kurhaluk N. Role of antioxidants in the neurobiology of drug addiction: An update. Biomed Pharmacother 2024; 175:116604. [PMID: 38692055 DOI: 10.1016/j.biopha.2024.116604] [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: 12/31/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024] Open
Abstract
Relationships between protective enzymatic and non-enzymatic pro-antioxidant mechanisms and addictive substances use disorders (SUDs) are analyzed here, based on the results of previous research, as well as on the basis of our current own studies. This review introduces new aspects of comparative analysis of associations of pro-antixidant and neurobiological effects in patients taking psychoactive substances and complements very limited knowledge about relationships with SUDs from different regions, mainly Europe. In view of the few studies on relations between antioxidants and neurobiological processes acting in patients taking psychoactive substances, this review is important from the point of view of showing the state of knowledge, directions of diagnosis and treatment, and further research needed explanation. We found significant correlations between chemical elements, pro-antioxidative mechanisms, and lipoperoxidation in the development of disorders associated with use of addictive substances, therefore elements that show most relations (Pr, Na, Mn, Y, Sc, La, Cr, Al, Ca, Sb, Cd, Pb, As, Hg, Ni) may be significant factors shaping SUDs. The action of pro-antioxidant defense and lipid peroxidation depends on the pro-antioxidative activity of ions. We explain the strongest correlations between Mg and Sb, and lipoperoxidation in addicts, which proves their stimulating effect on lipoperoxidation and on the induction of oxidative stress. We discussed which mechanisms and neurobiological processes change susceptibility to SUDs. The innovation of this review is to show that addicted people have lower activity of dismutases and peroxidases than healthy ones, which indicates disorders of antioxidant system and depletion of enzymes after long-term tolerance of stressors. We explain higher level of catalases, reductases, ceruloplasmin, bilirubin, retinol, α-tocopherol and uric acid of addicts. In view of poorly understood factors affecting addiction, analysis of interactions allows for more effective understanding of pathogenetic mechanisms leading to formation of addiction and development the initiation of directed, more effective treatment (pharmacological, hormonal) and may be helpful in the diagnosis of psychoactive changes.
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Affiliation(s)
- Piotr Kamiński
- Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Division of Medical Biology and Biochemistry, Division of Ecology and Environmental Protection, M. Skłodowska-Curie St. 9, Bydgoszcz PL 85-094, Poland; University of Zielona Góra, Faculty of Biological Sciences, Institute of Biological Sciences, Department of Biotechnology, Prof. Z. Szafran St. 1, Zielona Góra PL 65-516, Poland.
| | - Małgorzata Lorek
- Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Division of Medical Biology and Biochemistry, Division of Ecology and Environmental Protection, M. Skłodowska-Curie St. 9, Bydgoszcz PL 85-094, Poland
| | - Jędrzej Baszyński
- Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Division of Medical Biology and Biochemistry, Division of Ecology and Environmental Protection, M. Skłodowska-Curie St. 9, Bydgoszcz PL 85-094, Poland
| | - Tadeusz Tadrowski
- Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Department of Dermatology and Venereology, Faculty of Medicine M. Skłodowska-Curie St. 9, Bydgoszcz PL 85-094, Poland
| | - Edward Jacek Gorzelańczyk
- Kazimierz Wielki University in Bydgoszcz, Institute of Philosophy, M.K. Ogińskiego St. 16, Bydgoszcz PL 85-092, Poland; Adam Mickiewicz University in Poznań, Faculty of Mathematics and Computer Science, Uniwersyt Poznański St, 4, Poznań PL 61-614, Poland; Primate Cardinal Stefan Wyszyński Provincial Hospital in Sieradz, Psychiatric Centre in Warta, Sieradzka St. 3, Warta PL 98-290, Poland; Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Department of Theoretical Foundations of Biomedical Sciences and Medical Computer Science, Faculty of Pharmacy, Jagiellońska St. 15, Bydgoszcz PL 85-067, Poland
| | - Julia Feit
- Pallmed sp. z o.o., W. Roentgen St. 3, Bydgoszcz PL 85-796, Poland
| | - Halina Tkaczenko
- Pomeranian University in Słupsk, Institute of Biology, Arciszewski St. 22 B, Słupsk PL 76-200, Poland
| | - Jakub Owoc
- National Institute of Geriatrics, Rheumatology and Rehabilitation named after prof. dr hab. Eleonora Reicher, MD, Spartańska St. 1, Warszawa PL 02-637, Poland
| | - Alina Woźniak
- Nicholaus Copernicus University, Collegium Medicum in Bydgoszcz, Department of Medical Biology and Biochemistry, M. Karłowicz St. 24, Bydgoszcz PL 85-092, Poland
| | - Natalia Kurhaluk
- Pomeranian University in Słupsk, Institute of Biology, Arciszewski St. 22 B, Słupsk PL 76-200, Poland
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Zainal NH, Soh CP, Van Doren N. Daily stress reactivity and risk appraisal mediates childhood parental abuse predicting adulthood psychopathology severity: An 18-year longitudinal mediation analysis. J Affect Disord 2024; 358:138-149. [PMID: 38663555 DOI: 10.1016/j.jad.2024.04.068] [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: 01/08/2024] [Revised: 04/07/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024]
Abstract
Identifying mechanisms of childhood abuse-adulthood psychopathology relations could facilitate preventive efforts, but most prior studies used cross-sectional or two-wave designs and did not test the effects of childhood maternal and paternal abuse separately. Our 18-year three-wave study thus determined if Wave 2 daily stress reactivity and risk appraisal severity mediated Wave 1 retrospectively-reported childhood maternal and paternal abuse on Wave 3 generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD), alcohol (AUD), and substance use disorder (SUD) self-rated symptom severity. Longitudinal structural equation modeling was employed, adjusting for Wave 1 psychopathology severity. Higher childhood maternal and paternal abuse consistently predicted greater future daily stress reactivity and risk appraisal, and these mediators subsequently predicted increased GAD, MDD, and PD, but not AUD and SUD severity. Daily stress reactivity and risk appraisal consistently mediated the pathways between childhood maternal and paternal abuse predicting heightened adulthood GAD, MDD, and PD (Cohen's d = 0.333-0.888) but not AUD and SUD severity. Mediation effect sizes were stronger for childhood maternal (24.5-83.0%) than paternal (19.5-56.0%) abuse as the predictor. The latent interaction between Wave 1 childhood maternal and paternal abuse did not moderate the effect of Wave 1 maternal or paternal abuse on any Wave 3 adulthood psychopathology severity through Wave 2 daily stress reactivity and risk appraisal. Our research emphasizes the urgent requirement for continuous evaluation and intervention initiatives in trauma-informed care, both in inpatient and outpatient treatment settings.
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Affiliation(s)
- Nur Hani Zainal
- Harvard Medical School, Department of Health Care Policy, United States of America; National University of Singapore, Department of Psychology, Singapore.
| | - Chui Pin Soh
- National University of Singapore, Department of Psychology, Singapore
| | - Natalia Van Doren
- University of California at San Francisco, Department of Psychiatry and Behavioral Sciences, United States of America
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Maher EJ, Stoner SA, Gerlinger J, Ferraro AC, Lepper-Pappan H. Study protocol for a randomized controlled trial of the Parent-Child Assistance Program: a case management and home visiting program for people using substances during pregnancy. Trials 2024; 25:264. [PMID: 38627843 PMCID: PMC11020811 DOI: 10.1186/s13063-024-08098-6] [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: 12/29/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Perinatal substance use can have significant adverse effects on maternal and child health and family stability. Few interventions are specifically designed to address this significant public health problem. The Parent-Child Assistance Program (PCAP) is a 3-year case management and home-visiting intervention that seeks to help birthing persons with at-risk substance use during pregnancy to achieve and maintain substance use disorder recovery and avoid exposing future children to substances prenatally. At-risk refers to a level of substance use that creates problems in the individuals' lives or puts them or their children at risk of harm either prenatally or postnatally. Although the program has consistently shown substantial pre- to post-intervention improvements in its participants, PCAP remains to be tested with a rigorous randomized controlled trial (RCT). This study protocol describes a randomized controlled trial that aims to examine the effectiveness of the intervention compared to services as usual in affecting primary outcomes related to substance use and family planning. Secondary outcomes will concern connection to recovery support services and family preservation. METHODS Using an intent-to-treat design, the study will recruit from two metro areas in Oklahoma and enroll 200 birthing individuals who are pregnant or up to 24 months postpartum with at-risk substance use during their current or most recent pregnancy. Participants will be randomly assigned, stratified by location, to receive either PCAP or services as usual for 3 years. Participants in the PCAP condition will meet with their case manager approximately biweekly over the course of the intervention period, in their local communities or in their own homes whenever possible. Case managers will assist with goal setting and provide practical assistance in support of participants' goals. Primary and secondary outcomes will be assessed at baseline and 12, 24, and 36 months post-baseline using the Addiction Severity Index interview and a self-administered survey. DISCUSSION Results from this trial will help to gauge the effectiveness of PCAP in improving parent and child well-being. Results will be reviewed by federal clearinghouses on home-visiting and foster care prevention to determine the strength of evidence of effectiveness with implications for federal financing of this program model at the state level. TRIAL REGISTRATION ClinicalTrials.gov NCT05534568. Registered on 6/8/2022.
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Affiliation(s)
- Erin J Maher
- Department of Sociology, University of Oklahoma, 780 Van Vleet Oval, Kaufman Hall 311, Norman, OK, 73019, USA.
| | - Susan A Stoner
- Department of Psychiatry & Behavioral Sciences, Addictions, Drug & Alcohol Institute, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, USA
| | - Julie Gerlinger
- Department of Sociology, University of Oklahoma, 780 Van Vleet Oval, Kaufman Hall 311, Norman, OK, 73019, USA
| | - A C Ferraro
- Department of Sociology, University of Oklahoma, 780 Van Vleet Oval, Kaufman Hall 311, Norman, OK, 73019, USA
| | - Heather Lepper-Pappan
- Department of Sociology, University of Oklahoma, 780 Van Vleet Oval, Kaufman Hall 311, Norman, OK, 73019, USA
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Jennings LK, Lander L, Lawdahl T, McClure EA, Moreland A, McCauley JL, Haynes L, Matheson T, Jones R, Robey TE, Kawasaki S, Moschella P, Raheemullah A, Miller S, Gregovich G, Waltman D, Brady KT, Barth KS. Characterization of peer support services for substance use disorders in 11 US emergency departments in 2020: findings from a NIDA clinical trials network site selection process. Addict Sci Clin Pract 2024; 19:26. [PMID: 38589934 PMCID: PMC11003047 DOI: 10.1186/s13722-024-00453-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Emergency departments (ED) are incorporating Peer Support Specialists (PSSs) to help with patient care for substance use disorders (SUDs). Despite rapid growth in this area, little is published regarding workflow, expectations of the peer role, and core components of the PSS intervention. This study describes these elements in a national sample of ED-based peer support intervention programs. METHODS A survey was conducted to assess PSS site characteristics as part of site selection process for a National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) evaluating PSS effectiveness, Surveys were distributed to clinical sites affiliated with the 16 CTN nodes. Surveys were completed by a representative(s) of the site and collected data on the PSS role in the ED including details regarding funding and certification, services rendered, role in medications for opioid use disorder (MOUD) and naloxone distribution, and factors impacting implementation and maintenance of ED PSS programs. Quantitative data was summarized with descriptive statistics. Free-text fields were analyzed using qualitative content analysis. RESULTS A total of 11 surveys were completed, collected from 9 different states. ED PSS funding was from grants (55%), hospital funds (46%), peer recovery organizations (27%) or other (18%). Funding was anticipated to continue for a mean of 16 months (range 12 to 36 months). The majority of programs provided "general recovery support (81%) Screening, Brief Intervention, and Referral to Treatment (SBIRT) services (55%), and assisted with naloxone distribution to ED patients (64%). A minority assisted with ED-initiated buprenorphine (EDIB) programs (27%). Most (91%) provided services to patients after they were discharged from the ED. Barriers to implementation included lack of outpatient referral sources, barriers to initiating MOUD, stigma at the clinician and system level, and lack of ongoing PSS availability due to short-term grant funding. CONCLUSIONS The majority of ED-based PSSs were funded through time-limited grants, and short-term grant funding was identified as a barrier for ED PSS programs. There was consistency among sites in the involvement of PSSs in facilitation of transitions of SUD care, coordination of follow-up after ED discharge, and PSS involvement in naloxone distribution.
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Affiliation(s)
- Lindsey K Jennings
- Department of Emergency Medicine, Medical University of South Carolina, 169 Ashley Avenue, MSC 300, Charleston, SC, 29425, USA.
| | - Laura Lander
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Tricia Lawdahl
- Faces and Voices of Recovery (FAVOR) Upstate, Greenville, SC, USA
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Angela Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jenna L McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Louise Haynes
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Timothy Matheson
- Center On Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, USA
| | | | - Thomas E Robey
- Providence Regional Medical Center Everett, Washington State University, Everett, WA, USA
| | - Sarah Kawasaki
- Departments of Psychiatry and Internal Medicine, Penn State Health, Hershey, PA, USA
| | - Phillip Moschella
- Department of Emergency Medicine, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Amer Raheemullah
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Suzette Miller
- Mercy Health - St. Elizabeth Youngstown Hospital, Youngstown, OH, USA
| | - Gina Gregovich
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Deborah Waltman
- Deaconess Hospital, MultiCare Health System, Spokane, WA, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly S Barth
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Rezapour T, Rafei P, Baldacchino A, Conrod PJ, Dom G, Fishbein DH, Kazemi A, Hendriks V, Newton N, Riggs NR, Squeglia LM, Teesson M, Vassileva J, Verdejo-Garcia A, Ekhtiari H. Neuroscience-informed classification of prevention interventions in substance use disorders: An RDoC-based approach. Neurosci Biobehav Rev 2024; 159:105578. [PMID: 38360332 PMCID: PMC11081014 DOI: 10.1016/j.neubiorev.2024.105578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 02/17/2024]
Abstract
Neuroscience has contributed to uncover the mechanisms underpinning substance use disorders (SUD). The next frontier is to leverage these mechanisms as active targets to create more effective interventions for SUD treatment and prevention. Recent large-scale cohort studies from early childhood are generating multiple levels of neuroscience-based information with the potential to inform the development and refinement of future preventive strategies. However, there are still no available well-recognized frameworks to guide the integration of these multi-level datasets into prevention interventions. The Research Domain Criteria (RDoC) provides a neuroscience-based multi-system framework that is well suited to facilitate translation of neurobiological mechanisms into behavioral domains amenable to preventative interventions. We propose a novel RDoC-based framework for prevention science and adapted the framework for the existing preventive interventions. From a systematic review of randomized controlled trials using a person-centered drug/alcohol preventive approach for adolescents, we identified 22 unique preventive interventions. By teasing apart these 22 interventions into the RDoC domains, we proposed distinct neurocognitive trajectories which have been recognized as precursors or risk factors for SUDs, to be targeted, engaged and modified for effective addiction prevention.
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Affiliation(s)
- Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Parnian Rafei
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Alex Baldacchino
- Division of Population and Behavioral Science, University of St Andrews School of Medicine, St Andrews, United Kingdom
| | - Patricia J Conrod
- CHU Sainte-Justine Research Center, Department of Psychiatry and Addiction, University of Montreal, Montreal, Canada
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Belgium
| | - Diana H Fishbein
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, NC, USA; College of Health and Human Development, Pennsylvania State University, PA, USA
| | - Atefeh Kazemi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Vincent Hendriks
- Parnassia Addiction Research Centre (PARC, Brijder Addiction Treatment), Zoutkeetsingel 40, The Hague 2512 HN, the Netherlands; Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Leiden, Netherlands
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Nathaniel R Riggs
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Lindsay M Squeglia
- Medical University of South Carolina, Psychiatry and Behavioral Sciences, Charleston, SC, USA
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Jasmin Vassileva
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, VIC, Australia
| | - Hamed Ekhtiari
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
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Barenie RE, Bateman BT, Connery HS, Tsacogianis T, Kesselheim AS. Rates and costs of drug testing practices for private payors in the outpatient setting in the United States, 2015-2019. J Subst Use Addict Treat 2024; 159:209243. [PMID: 38052268 DOI: 10.1016/j.josat.2023.209243] [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] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/08/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Clinical practice guidelines recommend drug testing patients who are receiving opioids chronically for pain or medication for a substance use disorder (SUD)-particularly opioid use disorder (OUD)-but practices vary due to a lack of consensus on testing frequency during follow-up. This study aimed to evaluate rates and costs of outpatient drug testing practices for patients receiving opioids for chronic pain or medication for an SUD. METHODS Using claims data from a large de-identified claims data warehouse, we conducted a retrospective cohort study of chronic opioid, buprenorphine, and naltrexone users between January 2015 and December 2019. We identified two cohorts-chronic opioid medication cohort (CO) and SUD-indicated medication cohort (SUD). We assessed drug testing rates during follow-up using procedure codes and costs using copayment, deductible, co-insurance, and out-of-pocket data. RESULTS Among 6,657,515 eligible claimants, 367,118 (5.5 %) received opioids chronically and 73,303 (1.1 %) received an SUD-indicated medication. The cumulative proportion of drug testing during follow-up was similar between cohorts (CO: 36 %; SUD: 35 %), but rate of testing was consistently twice as frequent for the SUD cohort. All cost variables for the first drug test were higher on average in the SUD cohort than the CO cohort except copay: deductible (SUD: $18.54; CO: $7.33); co-insurance (SUD: $10.36; CO: $2.53); out-of-pocket (SUD: $29.39; CO: $10.57); copay (CO: $0.71; SUD: $0.49) (all p < 0.001). CONCLUSIONS Overall proportion of drug testing was similar between cohorts, but testing frequency was at least double during follow-up in the SUD cohort. Most cost variables were higher in the SUD cohort. Whether the high cost of drug testing is a barrier to medication use or is associated with treatment discontinuation should be evaluated.
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Affiliation(s)
- Rachel E Barenie
- University of Tennessee Health Science Center College of Pharmacy, 881 Madison Ave, Memphis, TN 38163, United States of America.
| | - Brian T Bateman
- Perioperative and Pain Medicine and Chair of the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine; 300 Pasteur Dr Rm H3589, Stanford, CA 94305, United States of America.
| | - Hilary S Connery
- Clinical Director of Division of Alcohol, Drugs, and Addiction, 115 Mill Street, Belmont, MA 02478, United States of America.
| | - Theodore Tsacogianis
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA 02120, United States of America.
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA 02120, United States of America.
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12
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Meshberg-Cohen S, Cook JM, Bin-Mahfouz A, Petrakis IL. Written exposure therapy for veterans with co-occurring substance use disorders and PTSD: Study design of a randomized clinical trial. Contemp Clin Trials 2024; 139:107475. [PMID: 38365173 DOI: 10.1016/j.cct.2024.107475] [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: 11/28/2023] [Revised: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
There are high rates of posttraumatic stress disorder (PTSD) among treatment-seeking veterans with substance use disorders (SUD). While addiction programs traditionally do not address PTSD, there is evidence that trauma treatments for individuals with this comorbidity have improved PTSD and SUD outcomes. Written exposure therapy (WET), a five-session evidence-based psychotherapy (EBP) for PTSD, has high patient satisfaction, and lower dropout compared to other EBPs for PTSD. WET may be ideally suited for clinical settings that may not have the trauma expertise found in PTSD specialty clinics, given it requires less training time, treatment sessions, preparation time, and therapist involvement than existing EBPs, and no homework assignments. This paper describes the design, methodology, and protocol of a randomized clinical trial to evaluate whether treatment as usual (TAU) plus WET (n = 51) is superior to TAU plus a neutral topic writing condition (n = 51) on both PTSD and addiction outcomes for veterans in SUD treatment. The primary hypothesis is that participants assigned to TAU+WET, compared to those in TAU+ neutral topic writing, will report reduced symptoms of PTSD. The secondary hypothesis is that veterans receiving WET will have greater decreases in number of days of substance use compared to TAU+ neutral topic controls at follow-up. Assessments will take place at baseline, post-treatment, 8-week, and 12-week follow-up. Exploratory aims will examine the association between heart rate variability and treatment outcomes. If results prove promising, they will support WET as an effective brief, easy to disseminate, adjunct to current SUD treatment for veterans with comorbid PTSD. Trial registration: ClinicalTrials.gov ID NCT05327504.
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Affiliation(s)
- Sarah Meshberg-Cohen
- Yale University School of Medicine, Department of Psychiatry, United States of America; VA Connecticut Healthcare System, United States of America.
| | - Joan M Cook
- Yale University School of Medicine, Department of Psychiatry, United States of America
| | - Amirah Bin-Mahfouz
- Yale University School of Medicine, Department of Psychiatry, United States of America; VA Connecticut Healthcare System, United States of America
| | - Ismene L Petrakis
- Yale University School of Medicine, Department of Psychiatry, United States of America; VA Connecticut Healthcare System, United States of America
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13
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Tatangelo M, Landry R, Beaulieu D, Watson C, Knowlan S, Anawati A, Bodson A, Aubin N, Marsh DC, Leary T, Morin KA. Association of hospital-based substance use supports on emergency department revisits: a retrospective cohort study in Sudbury, Canada from 2018 to 2022. Harm Reduct J 2024; 21:71. [PMID: 38549074 PMCID: PMC10976798 DOI: 10.1186/s12954-024-00985-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 03/09/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND This study compares emergency department (ED) revisits for patients receiving hospital-based substance-use support compared to those who did not receive specialized addiction services at Health Sciences North in Sudbury, Ontario, Canada. METHODS The study is a retrospective observational study using administrative data from all patients presenting with substance use disorder (SUD) at Health Sciences North from January 1, 2018, and August 31, 2022 with ICD-10 codes from the Discharge Abstract Database (DAD) and the National Ambulatory Care Database (NACRS). There were two interventions under study: addiction medicine consult services (AMCS group), and specialized addiction medicine unit (AMU group). The AMCS is a consult service offered for patients in the ED and those who are admitted to the hospital. The AMU is a specialized inpatient medical unit designed to offer addiction support to stabilize patients that operates under a harm-reduction philosophy. The primary outcome was all cause ED revisit within 30 days of the index ED or hospital visit. The secondary outcome was all observed ED revisits in the study period. Kaplan-Meier curves were used to measure the proportion of 30-day revisits by exposure group. Odds ratios and Hazard Ratios were calculated using logistic regression models with random effects and Cox-proportional hazard model respectively. RESULTS A total of 5,367 patients with 10,871 ED index visits, and 2,127 revisits between 2018 and 2022 are included in the study. 45% (2,340/5,367) of patient were not admitted to hospital. 30-day revisits were less likely among the intervention group: Addiction Medicine Consult Services (AMCS) in the ED significantly reduced the odds of revisits (OR 0.53, 95% CI 0.39-0.71, p < 0.01) and first revisits (OR 0.42, 95% CI 0.33-0.53, p < 0.01). The AMU group was associated with lower revisits odds (OR 0.80, 95% CI 0.66-0.98, p = 0.03). For every additional year of age, the odds of revisits slightly decreased (OR 0.99, 95% CI 0.98-1.00, p = 0.01) and males were found to have an increased risk compared to females (OR 1.50, 95% CI 1.35-1.67, p < 0.01). INTERPRETATION We observe statistically significant differences in ED revisits for patients receiving hospital-based substance-use support at Health Sciences North. Hospital-based substance-use supports could be applied to other hospitals to reduce 30-day revisits.
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Affiliation(s)
- Mark Tatangelo
- Health Science North, Sudbury, ON, Canada
- ICES North, Sudbury, ON, Canada
| | | | | | | | | | - Alex Anawati
- Health Science North, Sudbury, ON, Canada
- Dr. Gilles Arcand Centre for Health Equity, Sudbury, ON, Canada
| | | | - Natalie Aubin
- Health Science North, Sudbury, ON, Canada
- Laurentian University, Sudbury, ON, Canada
| | - David C Marsh
- Health Science North, Sudbury, ON, Canada
- ICES North, Sudbury, ON, Canada
- Dr. Gilles Arcand Centre for Health Equity, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
- Laurentian University, Sudbury, ON, Canada
| | - Tara Leary
- Health Science North, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Kristen A Morin
- Health Science North, Sudbury, ON, Canada.
- ICES North, Sudbury, ON, Canada.
- Dr. Gilles Arcand Centre for Health Equity, Sudbury, ON, Canada.
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.
- Laurentian University, Sudbury, ON, Canada.
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14
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Clergue-Duval V, Lyonnet A, Azuar J, Icick R, Poireau M, Rollet D, Taright N, Questel F, Gasquet I, Vorspan F. Hospitalized cocaine detoxification patients in Paris, France: Increased patient levels and changing population characteristics since 2011. Therapie 2024:S0040-5957(24)00038-6. [PMID: 38582619 DOI: 10.1016/j.therap.2024.03.001] [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: 12/15/2023] [Revised: 02/08/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024]
Abstract
AIM OF THE STUDY The past twenty years have seen a rise in cocaine-related statistics in France, including cocaine use in the general population, emergency ward presentations of acute cocaine intoxication, cocaine use disorders related outpatient appointments and cocaine-related deaths. This study's objectives were to describe trends in patients' admission for specific cocaine detoxification as well as changes in patients' characteristics in the Assistance publique-Hôpitaux de Paris (AP-HP) hospitals group located in Paris region, France. METHODS We reviewed the international classification of diseases 10th edition (ICD-10) discharge codes of the AP-HP hospitals group between 2011 and 2021. In addition, medical reports of the largest addiction medicine ward were also analysed for changes across the years 2009, 2014, 2019 and 2022. RESULTS The regional database showed an almost 3-fold increase in cocaine-related disorders discharge codes between 2011 and 2019. This occurred due to a rise in hospital stays for cocaine dependence or cocaine acute intoxication prior to the fall in levels of inpatient stays associated with the coronavirus disease 2019 (COVID-19) pandemic. The in-depth analysis of inpatients' stays in the specialized addiction medicine ward also showed an increase in admissions for cocaine detoxification programs, with a prevalence of 1.19% in 2009 to 15.73% in 2022 (P=1.44×10-20). Inpatient characteristics showed significant changes, especially in 2022, namely: more daily users, less intravenous administration and less comorbid illicit substances use disorders, with heightened levels of cured hepatitis C patients (P<0.05). Inpatient prescriptions were primarily dopaminergic antagonists with sedatives properties (cyamemazine, loxapine and chlorpromazine), dopamine-receptors partial agonist (aripiprazole) and serotonin reuptake inhibitors. CONCLUSION The referral to hospital care for cocaine detoxification has increased in Paris region since 2011, coupled with changes in inpatients' characteristics. This trend has significant implications for the management of inpatient hospital services.
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Affiliation(s)
- Virgile Clergue-Duval
- Département de Psychiatrie et de Médecine Addictologique, site Lariboisière Fernand-Widal, APHP GHU Nord, Université Paris Cité, 75010 Paris, France; UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM, Université Paris Cité, 75006 Paris, France; FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France; UFR de Médecine, Université Paris Cité, 75006 Paris, France.
| | - Arthur Lyonnet
- Département de Psychiatrie et de Médecine Addictologique, site Lariboisière Fernand-Widal, APHP GHU Nord, Université Paris Cité, 75010 Paris, France; FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France
| | - Julien Azuar
- Département de Psychiatrie et de Médecine Addictologique, site Lariboisière Fernand-Widal, APHP GHU Nord, Université Paris Cité, 75010 Paris, France; UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM, Université Paris Cité, 75006 Paris, France; FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France
| | - Romain Icick
- Département de Psychiatrie et de Médecine Addictologique, site Lariboisière Fernand-Widal, APHP GHU Nord, Université Paris Cité, 75010 Paris, France; UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM, Université Paris Cité, 75006 Paris, France; FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France
| | - Margaux Poireau
- UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM, Université Paris Cité, 75006 Paris, France; FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France
| | - Dorian Rollet
- Département de Psychiatrie et de Médecine Addictologique, site Lariboisière Fernand-Widal, APHP GHU Nord, Université Paris Cité, 75010 Paris, France; UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM, Université Paris Cité, 75006 Paris, France; FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France
| | - Namik Taright
- APHP, Department of Medical Information, 75012 Paris, France
| | - Frank Questel
- Département de Psychiatrie et de Médecine Addictologique, site Lariboisière Fernand-Widal, APHP GHU Nord, Université Paris Cité, 75010 Paris, France; UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM, Université Paris Cité, 75006 Paris, France; FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France
| | | | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, site Lariboisière Fernand-Widal, APHP GHU Nord, Université Paris Cité, 75010 Paris, France; UMRS-1144 Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM, Université Paris Cité, 75006 Paris, France; FHU Network of Research in Substance Use Disorders (NOR-SUD), 75006 Paris, France; UFR de Médecine, Université Paris Cité, 75006 Paris, France
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15
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Ball A, Hadland S, Rodean J, Hall M, Mendoza J, Ahrens K. Trends in Substance-Related Visits Among Youth to US Children's Hospitals, 2016-2021: An Analysis of the Pediatric Health Information System Database. J Adolesc Health 2024:S1054-139X(24)00106-X. [PMID: 38530681 DOI: 10.1016/j.jadohealth.2024.02.016] [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: 04/19/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE This study evaluates recent trends in substance-related visits among youth visiting children's hospitals. METHODS We conducted a cross-sectional study of substance-related visits to pediatric hospitals within the Pediatric Health Information System database of youth aged 12-21 years from 2016 through 2021. Substance-related visits were defined as acute visits for International Classification of Diseases, 10th Revision Clinical Modification codes related to substance 'use', dependence, or overdoses for alcohol, cannabis, nicotine, opioids, sedatives, stimulants, hallucinogens, or other substances. Cumulative growth rate and stratified substance-related trends were calculated using generalized estimating equations. Predicted number of visits during the COVID-19 pandemic was generated using an auto-regressive time series analysis. RESULTS There were 106,793 substance-related visits involving 84,632 youth. From 2016 to 2021, substance-related visits increased by 47.9% and increased across all ages, demographics, regions, and payors. Visits of Hispanic youth experienced the greatest percentage growth (63.3%, p < .05) when compared to Non-Hispanic (NH) White (46.2%) or NH Black (49.8%) youth. All substances except sedatives experienced an increase in growth in visits. Cannabis accounted for the largest percentage of visits (52.2%) and experienced the greatest percentage growth during the study period (82.4%, p < .001). During the pandemic, publicly insured, female, NH Black, and Hispanic youth experienced a greater-than-predicted number of substance-related visits. DISCUSSION Substance-related visits to children's hospitals are increasing for all demographics and nearly all substances. There were substantial increases in visits for most minoritized youth with a disproportionate rise among Hispanic youth. Visits over the pandemic were concentrated among publicly insured, female, NH Black, and Hispanic youth. Equitable large-scale investment is needed to address the rising morbidity of substance use among adolescents.
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Affiliation(s)
- Alexis Ball
- Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Scott Hadland
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Mass General Hospital/Harvard Medical School, Boston, Massachusetts
| | | | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Jason Mendoza
- Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, Washington; Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kym Ahrens
- Division of Adolescent Medicine, Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington
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16
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Shahzad H, Ahmad M, Singh VK, Bhatti N, Yu E, Phillips FM, Khan SN. Predictive factors of symptomatic lumbar pseudoarthrosis following multilevel primary lumbar fusion. N Am Spine Soc J 2024; 17:100302. [PMID: 38322114 PMCID: PMC10844967 DOI: 10.1016/j.xnsj.2023.100302] [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: 07/14/2023] [Revised: 11/08/2023] [Accepted: 11/29/2023] [Indexed: 02/08/2024]
Abstract
Background Lumbar spinal fusion surgery is a well-established treatment for various spinal disorders. However, one of its complications, pseudoarthrosis, poses a significant concern. This study aims to explore the incidence, time and predictive factors contributing to pseudoarthrosis in patients who have undergone lumbar fusion surgery over a 10-year period. Methods Data for this research was sourced from the PearlDiver database where insurance claims of patients who underwent multilevel lumbar spinal fusion between 01/01/2010 and 10/31/2022 were examined for claims of pseudoarthrosis within the 10 years of their index procedure. A variety of demographic, comorbid, and surgical factors were assessed, including age, gender, Elixhauser Comorbidity Index (ECI), surgical approach, substance use disorders and history of spinal disorders. Statistical analyses, including chi-squared tests, multivariate analysis, and cox survival analysis were employed to determine significant associations. Results Among the 76,337 patients included in this retrospective study, 2.70% were diagnosed with symptomatic lumbar pseudoarthrosis at an average of 7.38 years in a 10-year follow-up. Multivariate and Cox hazard analyses revealed that significant predictors of symptomatic pseudoarthrosis development following multilevel primary lumbar fusion include vitamin D deficiency, osteoarthritis, opioid and NSAID use, tobacco use, and a prior history of congenital spine disorders. Conclusions In summary, this study revealed a 2.70% incidence of symptomatic lumbar pseudoarthrosis within 10 years of the index procedure. It highlighted several potential predictive factors, including comorbidities, surgical approaches, and substance use disorders, associated with the development of symptomatic pseudoarthrosis. Future research should focus on refining our understanding of these factors to improve patient outcomes and optimize healthcare resource allocation.
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Affiliation(s)
- Hania Shahzad
- The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, United States
| | - Moizzah Ahmad
- Wexner Medical Center, 410 W 10th Avenue, Columbus OH, 43210, United States
| | - Varun K. Singh
- The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, United States
| | - Nazihah Bhatti
- The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, United States
| | - Elizabeth Yu
- The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, United States
| | - Frank M. Phillips
- Rush University Medical Center, Department of Orthopedics, 1620 W Harrison St, Chicago, IL 60612, United States
| | - Safdar N. Khan
- The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, United States
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17
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Koller D, Mitjans M, Kouakou M, Friligkou E, Cabrera-Mendoza B, Deak JD, Llonga N, Pathak GA, Stiltner B, Løkhammer S, Levey DF, Zhou H, Hatoum AS, Kember RL, Kranzler HR, Stein MB, Corominas R, Demontis D, Artigas MS, Ramos-Quiroga JA, Gelernter J, Ribasés M, Cormand B, Polimanti R. Genetic contribution to the comorbidity between attention-deficit/hyperactivity disorder and substance use disorders. Psychiatry Res 2024; 333:115758. [PMID: 38335780 DOI: 10.1016/j.psychres.2024.115758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
We characterized the genetic architecture of the attention-deficit hyperactivity disorder-substance use disorder (ADHD-SUD) relationship by investigating genetic correlation, causality, pleiotropy, and common polygenic risk. Summary statistics from genome-wide association studies (GWAS) were used to investigate ADHD (Neff = 51,568), cannabis use disorder (CanUD, Neff = 161,053), opioid use disorder (OUD, Neff = 57,120), problematic alcohol use (PAU, Neff = 502,272), and problematic tobacco use (PTU, Neff = 97,836). ADHD, CanUD, and OUD GWAS meta-analyses included cohorts with case definitions based on different diagnostic criteria. PAU GWAS combined information related to alcohol use disorder, alcohol dependence, and the items related to alcohol problematic consequences assessed by the alcohol use disorders identification test. PTU GWAS was generated a multi-trait analysis including information regarding Fagerström Test for Nicotine Dependence and cigarettes per day. Linkage disequilibrium score regression analyses indicated positive genetic correlation with CanUD, OUD, PAU, and PTU. Genomic structural equation modeling showed that these genetic correlations were related to two latent factors: one including ADHD, CanUD, and PTU and the other with OUD and PAU. The evidence of a causal effect of PAU and PTU on ADHD was stronger than the reverse in the two-sample Mendelian randomization analysis. Conversely, similar strength of evidence was found between ADHD and CanUD. CADM2 rs62250713 was a pleiotropic SNP between ADHD and all SUDs. We found seven, one, and twenty-eight pleiotropic variants between ADHD and CanUD, PAU, and PTU, respectively. Finally, OUD, CanUD, and PAU PRS were associated with increased odds of ADHD. Our findings demonstrated the contribution of multiple pleiotropic mechanisms to the comorbidity between ADHD and SUDs.
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Affiliation(s)
- Dora Koller
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; Veterans Affairs Connecticut Healthcare Center, West Haven, CA, USA; Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Catalonia, Spain.
| | - Marina Mitjans
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Catalonia Spain; Sant Joan de Déu Research Institute (IR-SJD), Esplugues de Llobregat, Catalonia, Spain
| | - Manuela Kouakou
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA
| | - Eleni Friligkou
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; Veterans Affairs Connecticut Healthcare Center, West Haven, CA, USA
| | - Brenda Cabrera-Mendoza
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; Veterans Affairs Connecticut Healthcare Center, West Haven, CA, USA
| | - Joseph D Deak
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; Veterans Affairs Connecticut Healthcare Center, West Haven, CA, USA
| | - Natalia Llonga
- Psychiatric Genetics Unit, Group of Psychiatry Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; Veterans Affairs Connecticut Healthcare Center, West Haven, CA, USA
| | - Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; Veterans Affairs Connecticut Healthcare Center, West Haven, CA, USA
| | - Solveig Løkhammer
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Daniel F Levey
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; Veterans Affairs Connecticut Healthcare Center, West Haven, CA, USA
| | - Hang Zhou
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; Veterans Affairs Connecticut Healthcare Center, West Haven, CA, USA
| | - Alexander S Hatoum
- Department of Psychological and Brain Sciences, Washington University in Saint Louis, St. Louis, MO, USA
| | - Rachel L Kember
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, USA; Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, USA; VA San Diego Healthcare System, San Diego, CA, La Jolla, USA
| | - Roser Corominas
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Catalonia, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Catalonia Spain; Sant Joan de Déu Research Institute (IR-SJD), Esplugues de Llobregat, Catalonia, Spain; Biomedical Network Research Centre on Rare Disorders (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Ditte Demontis
- Department of Biomedicine - Human Genetics, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; Center for Genomics and Personalized Medicine, Aarhus, Denmark; The Novo Nordisk Foundation Center for Genomic Mechanisms of Disease, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - María Soler Artigas
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Psychiatric Genetics Unit, Group of Psychiatry Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Psychiatric Genetics Unit, Group of Psychiatry Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; Veterans Affairs Connecticut Healthcare Center, West Haven, CA, USA; Department of Genetics, Yale School of Medicine, New Haven, CT, USA; Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
| | - Marta Ribasés
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Psychiatric Genetics Unit, Group of Psychiatry Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Bru Cormand
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Catalonia, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Catalonia Spain; Sant Joan de Déu Research Institute (IR-SJD), Esplugues de Llobregat, Catalonia, Spain; Biomedical Network Research Centre on Rare Disorders (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CA, USA; Veterans Affairs Connecticut Healthcare Center, West Haven, CA, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA
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18
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Harris MG, Kazdin AE, Munthali RJ, Vigo DV, Stein DJ, Viana MC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade LH, Bunting B, Chardoul S, Gureje O, Hu C, Hwang I, Karam EG, Navarro-Mateu F, Nishi D, Orozco R, Sampson NA, Scott KM, Vladescu C, Wojtyniak B, Xavier M, Zarkov Z, Kessler RC. Factors associated with satisfaction and perceived helpfulness of mental healthcare: a World Mental Health Surveys report. Int J Ment Health Syst 2024; 18:11. [PMID: 38429785 PMCID: PMC10908125 DOI: 10.1186/s13033-024-00629-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Mental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health. METHODS Data were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248). RESULTS Most treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction. CONCLUSIONS Satisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments.
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Affiliation(s)
- Meredith G Harris
- School of Public Health, The University of Queensland, c/o QCMHR, Locked Bag 500, Archerfield, QLD, 4108, Australia.
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wolston Park Rd, Wacol, QLD, 4076, Australia.
| | - Alan E Kazdin
- Department of Psychology, Yale University, 2 Hillhouse Avenue- 208205, New Haven, CT, 06520, USA
| | - Richard J Munthali
- Department of Psychiatry, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada
| | - Daniel V Vigo
- Department of Psychiatry, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Dan J Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Rondebosch, Cape Town, ZA, 7925, South Africa
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Espirito Santo - ES, Rua Dr. Euríco de Águiar, 888/705, Vitoria, Espirito Santo - ES, 2905-600, Brazil
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, 2921 Stockton Blvd., Suite 1408, Sacramento, CA, 95817, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, P.O.Box 88, Al-Diwaniyah, Al-Qadisiyah, Iraq
| | - Jordi Alonso
- IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Pompeu Fabra University (UPF), Plaça de la Mercè, 10-12, Barcelona, 08002, Spain
| | - Laura Helena Andrade
- University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica - LIM 23, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, CEP 05403-010, Brazil
| | - Brendan Bunting
- School of Psychology, Ulster University, College Avenue, Londonderry, BT48 7JL, UK
| | - Stephanie Chardoul
- Survey Research Center, Institute for Social Research, University of Michigan, 330 Packard, Room G358, Ann Arbor, MI, 48104, USA
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, PMB, 5116, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, 518020, China
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Ashrafieh, 166378, Lebanon
- Faculty of Medicine, Balamand University, Rond Point Saloumeh, Sin el Fil, Beirut, Lebanon
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigacion y Formación en Salud Mental, Servicio Murciano de Salud, Murcia Health Service, C/ Lorca, nº 58. -El Palmar, Murcia, 30120, Spain
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, El Palmar, Murcia, 30120, Spain
- Centro de Investigación Biomédica en Red en Epidemíologia y Salud Pública, El Palmar, Murcia, 30120, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ricardo Orozco
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Calz. Mexico-Xochimilco 101, San Lorenzo Huipulco, Ciudad de México, 14370, Mexico
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand
| | - Cristian Vladescu
- National Institute for Health Services Management, 31 Vaselor Str, Bucharest, 21253, Romania
- University Titu Maiorescu, Dâmbovnicului no. 22, Bucharest, Romania
| | - Bogdan Wojtyniak
- National Institute of Public Health, National Research Institute, 24 Chocimska St, Warsaw, 00-791, Poland
| | - Miguel Xavier
- Faculdade Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, Lisbon, 1169-056, Portugal
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, 15, Acad. Ivan Geshov Blvd, Sofia, 1431, Bulgaria
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
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Zhu Y, Baldwin LM, Mooney LJ, Saxon AJ, Kan E, Hser YI. Co-occurring substance use disorders among patients with opioid use disorder in rural primary care clinics. J Subst Use Addict Treat 2024; 158:209269. [PMID: 38097045 DOI: 10.1016/j.josat.2023.209269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/10/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Co-occurring substance use disorders (SUDs) among individuals with opioid use disorder (OUD) are associated with additional impairment, overdose, and death. This study examined characteristics of patients who have OUD with and without co-occurring SUDs in rural primary care clinics. METHODS Secondary analysis used electronic health record (EHR) data from six rural primary care clinics, including demographics, diagnoses, encounters, and prescriptions of medication for OUD (MOUD), as well as EHR data from an external telemedicine vendor that provided MOUD to some clinic patients. The study population included all adult patients who had a visit to the participating clinics from October 2019 to January 2021. RESULTS We identified 1164 patients with OUD; 72.6 % had OUD only, 11.5 % had OUD and stimulant use disorder (OUD + StUD), and 15.9 % had OUD and other non-stimulant substance use disorder (OUD + Other). The OUD + StUD group had the highest rates of hepatitis C virus (25.4 % for OUD + StUD, 17.8 % for OUD + Other, and 7.5 % for OUD Only; p < 0.001) and the highest rates of mental health disorders (78.4 %, 69.7 %, and 59.9 %, respectively; p < 0.001). Compared to the OUD Only group, patients in the OUD + StUD and OUD + Other groups were more likely to receive telehealth services provided by clinic staff, in-clinic behavioral health services, and in-clinic MOUD. The OUD + StUD group had the highest proportion of referrals to the external telemedicine vendor. CONCLUSIONS More than 27 % of patients with OUD in rural primary care clinics had other co-occurring SUDs, and these patients received more healthcare services than those with OUD only. Future studies should examine variations in outcomes associated with these other services among patients with OUD and co-occurring SUDs.
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Affiliation(s)
- Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States of America
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, United States of America; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, United States of America
| | - Emily Kan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America.
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Adan A, Marquez-Arrico JE, Río-Martínez L, Navarro JF, Martinez-Nicolas A. Circadian rhythmicity in schizophrenia male patients with and without substance use disorder comorbidity. Eur Arch Psychiatry Clin Neurosci 2024; 274:279-290. [PMID: 36879135 PMCID: PMC10914872 DOI: 10.1007/s00406-023-01560-7] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/17/2023] [Indexed: 03/08/2023]
Abstract
Circadian rhythmicity is associated to clinical variables that play an important role in both schizophrenia (SZ) and substance use disorders (SUD), although the characteristics of the coexistence of these two diagnoses (SZ +) remain mostly unknown. Hence, we studied a sample of 165 male patients divided in three groups each of 55, according to their diagnoses (SZ + , SZ, and SUD), as well as a healthy control (HC; n = 90) group. Alongside with sociodemographic and clinical variables, circadian rhythms were registered through a sleep-wake data structured interview, a circadian typology questionnaire, and distal skin temperature (DST) using the Thermochron iButton every 2 min during 48 h. Analyses showed that SZ + and SZ patients presented a longer sleep (delay in wake-up time) and mostly an intermediate circadian typology, while SUD patients slept less hours, displaying a morning typology. The DST showed the highest daily activation and stability for the SUD group, even when compared with the HC group. The presence of schizophrenia (SZ + and SZ) was related to a DST pattern with a reduced amplitude determined by a wakefulness impairment, which was more pronounced for SZ patients whose sleep period was adequate. The assessment of circadian rhythms in under treatment male patients with SZ should be focused on the diurnal period as a possible marker of either treatment adherence or patient's recovery, irrespective of the presence of a comorbid SUD. Further research with additional objective measures may provide knowledge transferable to therapeutic strategies and could be useful to establish possible endophenotypes in the future.
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Affiliation(s)
- Ana Adan
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d'Hebrón 171, 08035, Barcelona, Spain.
- Institute of Neurosciences, University of Barcelona, 08035, Barcelona, Spain.
| | - Julia E Marquez-Arrico
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d'Hebrón 171, 08035, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, 08035, Barcelona, Spain
| | - Laura Río-Martínez
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d'Hebrón 171, 08035, Barcelona, Spain
| | - José Francisco Navarro
- Department of Psychobiology, School of Psychology, University of Málaga, Campus de Teatinos s/n, 29071, Málaga, Spain
| | - Antonio Martinez-Nicolas
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, 30100, Murcia, Spain
- Human Physiology Area, Faculty of Sport Sciences, University of Murcia, Santiago de La Ribera-San Javier, 30720, Murcia, Spain
- CIBER Fragilidad y Envejecimiento Saludable, Instituto de Salud Carlos III, 28029, Madrid, Spain
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21
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Kose J, Duquenne P, Hercberg S, Galan P, Touvier M, Fezeu LK, Andreeva VA. Co-occurrence of habit-forming risk behaviors and their socio-demographic, health status and lifestyle determinants: a population-based cross-sectional study. Arch Public Health 2024; 82:26. [PMID: 38419088 PMCID: PMC10900606 DOI: 10.1186/s13690-024-01251-2] [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: 10/31/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Although habit-forming risk behaviors frequently co-occur, determinants of concurrent risk behaviors have rarely been investigated. The aim of the present study was to investigate socio-demographic, health status, and lifestyle determinants of single versus concurrent risk behaviors in general-population adults. METHODS We analyzed data from 32,622 participants (74.5% female; mean age = 57.9 ± 14.2 years) of the NutriNet-Santé cohort who completed the Alcohol Use Disorders Identification Test, the 12-item Cigarette Dependence Scale, the modified Yale Food Addiction Scale 2.0, and the Internet Addiction Test in 2021-2022. Using established cutoffs, participants were first split into 2 groups (presence versus absence) for each risk variable (alcohol use disorders, nicotine dependence, food addiction, Internet addiction) and were then divided into 3 groups (no risk behavior, 1 risk behavior (reference), and ≥ 2 risk behaviors). The association between socio-demographic, health status, and lifestyle exposures and individual/concurrent risk behaviors were investigated with polytomous logistic regression. RESULTS Younger age (Odds Ratio (OR) = 2.04; 95% Confidence Interval (CI: 1.62-2.56), current financial difficulties (OR = 1.29; CI: 1.08-1.54), self-perceived poor health (OR = 1.70; CI: 1.32-2.20), overall poor dietary quality (OR = 2.88; CI: 2.06-4.02), being underweight (OR = 1.46; CI: 1.05-2.04), having obesity (OR = 1.62; CI: 1.31-1.99), lack of affection during childhood (OR = 1.41; CI: 1.18-1.69), and a lifetime prevalence or medication use for a mental disorder (OR = 1.46; CI: 1.24-1.73) were positively associated with having ≥ 2 versus 1 risk behavior (all p < 0.05). The comparison of none versus 1 risk behavior revealed the same determinants in addition to having a higher education, being physically active at work, and being overweight. CONCLUSIONS We investigated determinants of concurrent habit-forming risk behaviors among adults in a large, population-based study. The findings could serve as impetus for future research in this domain and ultimately help guide addiction prevention efforts.
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Affiliation(s)
- Junko Kose
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
| | - Pauline Duquenne
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
| | - Serge Hercberg
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
- Department of Public Health, AP-HP Paris Seine-Saint-Denis Hospital System, Bobigny, France
| | - Pilar Galan
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
| | - Mathilde Touvier
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
| | - Léopold K Fezeu
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France
| | - Valentina A Andreeva
- Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, University of Paris (CRESS), Bobigny, France.
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Beaugard CA, Khudairi F, Yesufu O, Farina A, Laks J. "I don't think of it as a shelter. I say I'm going home": a qualitative evaluation of a low-threshold shelter for women who use drugs. Harm Reduct J 2024; 21:44. [PMID: 38374063 PMCID: PMC10877776 DOI: 10.1186/s12954-024-00930-1] [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: 09/29/2023] [Accepted: 01/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In 2021-2022, encampments in a downtown Boston neighborhood reached record heights, increasing the visibility of drug use and homelessness in the city. In response, the city planned a "sweep" (i.e., eradication of encampments) and requested support from social services and medical providers to pilot low-threshold shelters. Low-threshold shelters reduce barriers to staying in traditional congregate shelters with more flexible regulations, longer-term bed assignments, and secured storage for contraband (e.g., drugs, weapons) instead of forced disposal. One homeless service provider opened a harm reduction-focused shelter for women who use drugs. This report describes the low-threshold shelter design and program evaluation. METHODS This program evaluation had two primary aims: (1) to examine guests' beliefs about shelter policies and practices; and (2) to understand the staff's experiences working in a low-threshold model. We conducted semi-structured qualitative interviews with 16 guests and 12 staff members during the summer 2022. Interviews were thematically analyzed. RESULTS Guests expressed overwhelming approval for the shelter's policies, which they stated supported their autonomy, dignity, and safety. They emphasized the staff's willingness to build relationships, thus demonstrating true commitment to the guests. Guests highlighted the value of daytime access to the shelter, as it granted them autonomy over their time, reduced their substance use, and helped them build relationships with staff and other guests. The co-directors and staff designed the shelter quickly and without US models for reference; they turned to international literature, local harm reduction health care providers, and women living in encampments for guidance on the shelter policies. The staff were passionate and committed to the health and stability of the guests. Most staff found value in the low-threshold model, though some were challenged by it, believing it enabled drug use and did not require the guests to "get better." CONCLUSIONS This evaluation indicates the value of low-threshold, harm reduction shelters as alternatives to traditional models. While these shelters do not mitigate the need for overarching housing reform, they are important measures to meet the needs of women experiencing unsheltered homelessness who face intersectional oppression.
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Affiliation(s)
- Corinne A Beaugard
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA, 02215, USA.
- , 801 Massachusetts Avenue, Crosstown Building 4th Floor, Suite 400, Boston, MA, 02180, USA.
| | - Fay Khudairi
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Oluwatoyin Yesufu
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Andrea Farina
- St. Francis House, 39 Boylston St, Boston, MA, 02116, USA
| | - Jordana Laks
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
- Chobanian and Avedisian School of Medicine, Department of Internal Medicine, Boston University, 801 Massachusetts Ave 6th Floor, Boston, MA, 02119, USA
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23
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Bukten A, Virtanen S, Hesse M, Chang Z, Kvamme TL, Thylstrup B, Tverborgvik T, Skjærvø I, Stavseth MR. The prevalence and comorbidity of mental health and substance use disorders in Scandinavian prisons 2010-2019: a multi-national register study. BMC Psychiatry 2024; 24:95. [PMID: 38317111 PMCID: PMC10840271 DOI: 10.1186/s12888-024-05540-6] [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: 08/11/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Mental health disorders are common among people in prison, but their prevalence in the Scandinavian prison population remain unclear. In this multinational register study, we examined the prevalence of mental health disorders and the comorbidity of substance use disorders (SUDs) with other mental health disorders in this population. Further, we investigated how the prevalence of mental disorders at prison entry had changed in Norway, Denmark, and Sweden over the study period. METHODS The three study cohorts included all individuals, aged 19 or older, whom had been imprisoned in Norway (2010-2019), Denmark (2011-2018), and Sweden (2010-2013). Mental disorders were defined as ICD-10 diagnoses (F-codes) registered in the national patient registers. The study prevalence was estimated based on recorded diagnoses during the entire study follow-up period in each respective country. The one-year prevalence of mental disorders was estimated for each calendar year for individuals entering prison during that year. RESULTS The Scandinavian prison cohorts included 119 507 individuals released 191 549 times during the study period. Across all three countries a high proportion of both women (61.3%-74.4%) and men (49.6%-57.9%) had at least one mental health disorder during the observation period. The most prevalent disorders were SUDs (39.1%-44.0%), depressive disorder (8.1%-17.5%), and stress related disorder (8.8%-17.1%). Women (31.8%-41.1%) had higher levels of mental health and substance use comorbidities compared to men (20.8%-27.6%). The one-year prevalence of any mental health disorder increased over time with a 33% relative increase in Norway, 8% in Denmark, and 10% in Sweden. The proportion of individuals entering prison with a comorbid SUD and other mental disorder had also increased. CONCLUSIONS While the incarceration rate has been decreasing during the past decade in the Scandinavian countries, an increasing proportion of people entering prison have a diagnosed mental health disorder. Our results suggest that prisons should provide adequate treatment and scale up services to accommodate the increasing proportion of people with complex health needs among incarcerated people.
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Affiliation(s)
- Anne Bukten
- Norwegian Centre for Addiction Research, University of Oslo, Kirkeveien 166, Oslo, N-0407, Norway.
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | - Suvi Virtanen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Morten Hesse
- Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Birgitte Thylstrup
- Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Torill Tverborgvik
- Norwegian Centre for Addiction Research, University of Oslo, Kirkeveien 166, Oslo, N-0407, Norway
| | - Ingeborg Skjærvø
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Marianne R Stavseth
- Norwegian Centre for Addiction Research, University of Oslo, Kirkeveien 166, Oslo, N-0407, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Montoya ID, Volkow ND. IUPHAR Review: New strategies for medications to treat substance use disorders. Pharmacol Res 2024; 200:107078. [PMID: 38246477 PMCID: PMC10922847 DOI: 10.1016/j.phrs.2024.107078] [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: 12/13/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
Substance use disorders (SUDs) and drug overdose are a public health emergency and safe and effective treatments are urgently needed. Developing new medications to treat them is expensive, time-consuming, and the probability of a compound progressing to clinical trials and obtaining FDA-approval is low. The small number of FDA-approved medications for SUDs reflects the low interest of pharmaceutical companies to invest in this area due to market forces, characteristics of the population (e.g., stigma, and socio-economic and legal disadvantages), and the high bar regulatory agencies set for new medication approval. In consequence, most research on medications is funded by government agencies, such as the National Institute on Drug Abuse (NIDA). Multiple scientific opportunities are emerging that can accelerate the discovery and development of new medications for SUDs. These include fast and efficient tools to screen new molecules, discover new medication targets, use of big data to explore large clinical data sets and artificial intelligence (AI) applications to make predictions, and precision medicine tools to individualize and optimize treatments. This review provides a general description of these new research strategies for the development of medications to treat SUDs with emphasis on the gaps and scientific opportunities. It includes a brief overview of the rising public health toll of SUDs; the justification, challenges, and opportunities to develop new medications; and a discussion of medications and treatment endpoints that are being evaluated with support from NIDA.
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Affiliation(s)
- Ivan D Montoya
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, 3 White Flint North, North Bethesda, MD 20852, United States.
| | - Nora D Volkow
- National Institute on Drug Abuse, 3 White Flint North, North Bethesda, MD 20852, United States
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Arnaud N, Wartberg L, Simon-Kutscher K, Thomasius R. Prevalence of substance use disorders and associations with mindfulness, impulsive personality traits and psychopathological symptoms in a representative sample of adolescents in Germany. Eur Child Adolesc Psychiatry 2024; 33:451-465. [PMID: 36853515 PMCID: PMC9972301 DOI: 10.1007/s00787-023-02173-0] [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: 11/05/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
Adolescence is a critical phase for the development of substance use disorders (SUDs). For Europe and Germany, there are limited data on problematic substance use from representative youth samples. Trait mindfulness is relevant in buffering against substance use-related problems and associated deficits in self-regulatory control. The objective of this study is to estimate 12-month prevalence rates for SUDs in a representative sample of adolescents in Germany and to examine associations with mindfulness and related factors such as stress, impulsivity, sensation seeking and symptoms of psychopathology. A sample of 4001 adolescents aged 12-18 years from Germany was surveyed based on DSM-IV diagnostic criteria for SUDs. Logistic regression analyses were used to examine associations with mindfulness-related variables. Criteria of at least one of the assessed SUDs were endorsed by 11.2% of the adolescents. Alcohol use disorders had the highest prevalence rate (10.1%) followed by cannabis use disorders (2.6%). For both substances, the criteria for abuse were met about twice as often as those for dependence. The prevalence of cigarette dependence was 1.7%, while the prevalence for e-cigarette dependence was only 0.1%. Prevalence rates were higher for male youth and increasing with age. SUD prevalence was also related to mindfulness, impulsivity and sensation seeking and externalizing symptoms of psychopathology. The statistically significant associations varied across different SUDs. SUDs appear highly prevalent among German adolescents. The results have public health implications with regard to treatment needs and prevention measures in the youth population in Germany.
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Affiliation(s)
- Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Lutz Wartberg
- Medical School Hamburg (MSH), Faculty of Human Sciences, Department of Psychology, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - Kathrin Simon-Kutscher
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Rainer Thomasius
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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26
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Pautrat M, Barbier E, Lebeau JP. Identifying available substance use disorder screening tests feasible for use in primary care: A systematic review. Prev Med Rep 2024; 38:102610. [PMID: 38375183 PMCID: PMC10874871 DOI: 10.1016/j.pmedr.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Substance use disorders substantially contribute to the global burden of disease. Early detection in primary care is recommended, and numerous screening tests are available. However, barriers to addictive disorder screening exist and the feasibility of using these tests in primary care is unclear. This study aims to identify available addictive disorder screening tests whose feasibility has been evaluated in primary care. This systematic literature review was performed using Pubmed, PsycINFO, and the Cochrane Library databases. The search strategy included four research topics: addictive disorders, screening, primary care, and feasibility. Selection criteria included published studies evaluating the feasibility of an addictive disorder screening test in primary care. Data were extracted for each included article, and each analyzed screening test. Of the 4911 articles selected, 20 were included and 16 screening tests were studied. Physician feasibility was evaluated with satisfaction questionnaires or qualitative studies, mainly measuring test administration time. Patient feasibility was measured using criteria including "ease of use", comprehension, or format preference. Self-administered formats were preferred, especially electronic versions. Overall, the TAPS (Tobacco, Alcohol, Prescription medication, and other Substance use) tool provides a good balance between ease of use, brevity of administration and more extensive screening for substance use disorders. Feasibility appears to be a set of heterogeneous criteria relating to users, including comprehension or satisfaction, and practical aspects, including administration time or format preference. The criteria synthesized in this review could serve as a basis for screening test feasibility studies in primary care given the absence of feasibility study guidelines.
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Affiliation(s)
- Maxime Pautrat
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
| | | | - Jean Pierre Lebeau
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
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Nakhaee N, Karamouzian M, Sharifi H, Malekshahi K, Moaddeb KA, Vahidzadeh A, Iranpour A. The effectiveness of court-mandated compulsory treatment in promoting abstinence among people with substance use disorders in Iran. Int J Drug Policy 2024; 124:104325. [PMID: 38232440 DOI: 10.1016/j.drugpo.2024.104325] [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: 08/19/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND In Iran, people living with substance use disorders who engage in public drug use may be subjected to court-mandated treatment in compulsory drug detention and rehabilitation centers (CDDRC). This study aims to assess residential CDDRC's effectiveness in promoting sustained abstinence among people who use drugs (PWUD) in Kerman, Iran. METHODS Between October 1, 2021, and September 30, 2022, 1,083 adult male PWUD with a diagnosis of substance use disorders and a history of engagement in public drug use were admitted to the CDDRC in Kerman. They were followed-up for 12 months after discharge. The relationship between baseline variables and abstinence, assessed using rapid urine tests, was examined using crude logistic regression models. RESULTS Most PWUD were 30 or older (n = 876, 80.9 %) and had a history of previous CDDRC admission (n = 638, 58.9 %). At the end of the 12-month follow-up, only 2.6 % (95 % confidence intervals: 1.7-3.7) were abstinent. Individuals with limited education (Odds ratio [OR] = 3.43; 1.50-7.95) and those with a prior history of admission to the CDDRC (OR = 3.73; 1.55-9.89) had increased odds of relapse. CONCLUSIONS The effectiveness of CDDRC in promoting abstinence among the participants was minimal. This highlights the necessity of reassessing support and investment in these interventions and considering more evidence-informed alternative approaches in Iran.
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Affiliation(s)
- Nouzar Nakhaee
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | | | - Abedin Iranpour
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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28
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Su KY, Feldman BJ, Feldman CT, Saluja S, Coulourides Kogan AM, Cousineau MR. Behavioral Health Care Delivery Through Street Medicine Programs in California. Community Ment Health J 2024; 60:283-291. [PMID: 37526807 PMCID: PMC10822007 DOI: 10.1007/s10597-023-01169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
Mental health and substance use disorders are prevalent among people experiencing homelessness. Street Medicine can reach unhoused people who face barriers to accessing healthcare in more traditional medical settings including shelter-based clinics. However, there is little guidance on best practices for mental health and substance use treatment through Street Medicine. The aim of the study was to describe behavioral health care through Street Medicine by analyzing data from the California Street Medicine Landscape survey and follow-up qualitative interviews. Most street medicine programs utilize non-psychiatrists to diagnose and treat mental health and substance use disorders, though the capacity to provide the level of care needed varies. There is a lack of street-based psychiatric clinicians and programs have difficulty making referrals to mental health and addiction services. This report shows that Street Medicine could serve as a strategy to expand access to behavioral health care for the unhoused.
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Affiliation(s)
- Kimberly Y Su
- Keck School of Medicine of USC, Los Angeles, CA, USA.
| | | | | | - Sonali Saluja
- Keck School of Medicine of USC, Los Angeles, CA, USA
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29
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Nwanaji-Enwerem U, Sadler LS, O'Connell M, Barry D, Knobf TM, Jeon S, Scheinost D, Yaggi K, Redeker NS. "It's all connected:" A mixed methods study of insomnia, stigma, and discrimination among individuals on medication for opioid use disorder. Sleep Health 2024; 10:31-40. [PMID: 37980246 DOI: 10.1016/j.sleh.2023.09.004] [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: 03/14/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Insomnia is one of the most common sleep disorders among those with opioid use disorder (OUD), including those on medication for OUD. There is a dearth of literature exploring the role of social stressors on sleep outcomes among this group. The purpose of this study was to explore the association between OUD-related stigma and intersectional discrimination with insomnia among individuals on medication for OUD. METHODS Participants were recruited from treatment clinics in the Northeast United States. Using a convergent mixed-methods research design, we explored associations with stigma (The Brief Opioid Stigma Scale), intersectional discrimination (Intersectional Discrimination Index), and insomnia (Insomnia Severity Index) through quantitative survey data and qualitative data from interviews for participant experiences. Data from the quantitative (n = 120) and qualitative (n = 25) components of the study were integrated for interpretation. RESULTS Quantitative analysis indicated weak to moderate positive correlations between intersectional discrimination, and exploratory variables including pain, perceived stress, and psychological distress with insomnia severity. The qualitative analysis generated 4 main themes, which highlighted negative emotions and ruminations as factors that participants connected experiences with stigma and discrimination to poor sleep outcomes. Integration of data identified concordant and discordant findings. CONCLUSIONS Stigma, discrimination, physical symptoms, and psychological distress appear to contribute to poor sleep outcomes among those with OUD. Future research should target maladaptive outcomes of rumination and negative emotions to improve sleep outcomes among those with OUD.
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Affiliation(s)
- Uzoji Nwanaji-Enwerem
- Yale School of Nursing, Orange, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA.
| | - Lois S Sadler
- Yale School of Nursing, Orange, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Meghan O'Connell
- UCONN School of Nursing, Storrs, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Declan Barry
- APT Foundation, New Haven, Connecticut, USA; Yale School of Medicine, New Haven, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Tish M Knobf
- Yale School of Nursing, Orange, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Sangchoon Jeon
- Yale School of Nursing, Orange, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Dustin Scheinost
- Yale School of Medicine, New Haven, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Klar Yaggi
- Yale School of Medicine, New Haven, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
| | - Nancy S Redeker
- UCONN School of Nursing, Storrs, Connecticut, USA; Yale School of Public Health, New Haven, Connecticut, USA
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30
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Marti L, Hünerwadel E, Hut B, Christ SM, Däster F, Schettle M, Seiler A, Blum D, Hertler C. Characteristics and clinical challenges in patients with substance use disorder in palliative care-experience from a tertiary center in a high-income country. BMC Palliat Care 2024; 23:28. [PMID: 38287302 PMCID: PMC10826251 DOI: 10.1186/s12904-024-01366-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Access to palliative care is often limited for challenging and vulnerable groups, including persons with substance use disorders. However, with optimized healthcare options and liberal substitution policies, this patient group is likely to increase over the upcoming years, and comorbidities will also influence the need for palliative support. Here, we aim at analyzing characteristics and specific challenges associated with substance use disorders (SUD) in palliative care. METHODS We retrospectively reviewed all patients diagnosed with substance use disorder that were treated at our Competence Center Palliative Care within the University Hospital Zurich, Switzerland between 2015 and 2021. Patient characteristics, including age, gender, duration of hospitalization, as well as specific metrics like body mass index, distinct palliative care assessment scores, and in-hospital opioid consumption were retrieved from the electronic patient files. Demographics and clinical data were analyzed by descriptive statistics, and compared to those of a control group of palliative care patients without SUD. An opioid calculator was used to standardize opioid intake based on morphine equivalents for meaningful comparisons. RESULTS The primary characteristics revealed that the majority of individuals were single (56%), had no children (83%), lived alone (39%), and were either unemployed or recipients of a disability pension (in total 50%). Nicotine (89%), opioids (67%), and alcohol (67%) were the most used substances. We identified various comorbidities including psychiatric illnesses alongside SUD (56%), hepatitis A, B, or C (33%), and HIV infection (17%). Patients with SUD were significantly younger (p < 0.5), predominantly male (p < 0.05), and reported a higher prevalence of pain (p < 0.5) compared to the standard cohort of palliative patients. Regarding the challenges most frequently reported by healthcare practitioners, non-compliance, multimorbidity, challenging communication, biographical trauma, lack of social support, and unstable housing situations played a key role. CONCLUSION Patients with SUD represent a complex and vulnerable group dealing with multiple comorbidities that profoundly affect both their physical and psychological well-being. Understanding their unique characteristics is pivotal in providing precise and suitable palliative care.
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Affiliation(s)
| | | | - Bigna Hut
- University of Zurich, Zurich, Switzerland
| | - Sebastian M Christ
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Fabienne Däster
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Markus Schettle
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Annina Seiler
- University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - David Blum
- University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Caroline Hertler
- University of Zurich, Zurich, Switzerland.
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland.
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Kiive E, Kurrikoff T, Veidebaum T, Harro J. To Each His Own Fear: Gender-Related Association of Anxiety, Substance Use, and Eating Disorders in a Representative Birth Cohort Sample of Young Adults with Either COMT Val158Met allele. Neuropsychobiology 2024; 83:41-48. [PMID: 38228118 PMCID: PMC10871680 DOI: 10.1159/000535912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION The role of catechol-O-methyltransferase (COMT) in catecholamine neurotransmitter metabolism has led to the investigation of variants of the corresponding gene in the etiology of different psychiatric disorders, but the results are inconclusive. METHODS We have examined the relationship between COMT Val158Met single nucleotide polymorphism (rs4680) and the occurrence of psychiatric disorders in a highly representative birth cohort sample of young adults in the Estonian Children Personality Behaviour and Health Study (original n = 1,238). The lifetime occurrence of psychiatric disorders at the age of 25 years was assessed with the Mini-International Neuropsychiatric Interview. RESULTS Both Val- and Met-alleles of the COMT Val158Met were associated with specific psychiatric disorders. Met-allele carriers had a significantly higher occurrence of agoraphobia (3.2% vs. 0.5%; χ2 = 4.10; p < 0.05) compared to Val/Val homozygotes. Also, the occurrence of panic disorder was significantly higher in female Met-allele carriers than in Val/Val homozygote females (10.2% vs. 3.6%; χ2 = 4.62 p = 0.03). In contrast, the occurrence of generalized anxiety disorder was higher in Val/Val females when compared to Met-allele carriers (12.7% vs. 6.8%; χ2 = 4.16; p = 0.04). Also, female Val/Val homozygotes (15.5%) had a higher occurrence of eating disorders than Met-allele carriers (6.1%) of the COMT Val158Met polymorphism (χ2 = 10.39; p = 0.002). In the whole sample, Met-allele homozygotes had a higher occurrence of alcohol use and substance use disorders than Val-allele carriers (χ2 = 3.62 and 3.68, respectively; p < 0.05). CONCLUSION In a regional highly birth cohort representative sample, either COMT rs4680 variant was observed in association with specific psychiatric disorders.
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Affiliation(s)
- Evelyn Kiive
- Division of Special Education, Department of Education, University of Tartu, Tartu, Estonia
| | - Triin Kurrikoff
- Division of Neuropsychopharmacology, Department of Chemistry, University of Tartu, Tartu, Estonia
| | - Toomas Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
| | - Jaanus Harro
- Division of Neuropsychopharmacology, Department of Chemistry, University of Tartu, Tartu, Estonia
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Janson S, Nyenga L, Saleem H, Mayo-Wilson LJ, Mushy SE, Iseselo MK, van Draanen J, Tucker J, McPherson M, Conserve DF. Residential and inpatient treatment of substance use disorders in Sub-Saharan Africa: a scoping review. Subst Abuse Treat Prev Policy 2024; 19:6. [PMID: 38212834 PMCID: PMC10782522 DOI: 10.1186/s13011-023-00589-0] [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: 10/15/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND With substance use rates increasing in Sub-Saharan Africa (SSA), an understanding of the accessibility and effectiveness of rehabilitative services for people who use alcohol and other drugs (AOD) is critical in the global efforts to diagnose and treat substance use disorders (SUD). This scoping review seeks to address the gaps in knowledge related to the types of research that have been conducted regarding inpatient or residential SUD treatment in SSA, the settings in which the research was conducted, and the study countries. METHODS A search of three databases, PubMED, Scopus, and African Index Medicus, was conducted for publications related to the treatment of SUD in inpatient or residential settings in SSA. Articles were screened at the title/abstract level and at full text by two reviewers. Articles eligible for inclusion were original research, conducted in SSA, published in English, included populations who received or were currently receiving treatment for SUD in inpatient or residential settings, or documented demand for SUD services. RESULTS This scoping review included 82 studies originating from 6 countries in SSA. Three themes emerged within the literature: access and demand for inpatient and residential SUD treatment, quality and outcomes of SUD treatment, and descriptions of the services offered and staffing of these facilities. Barriers to access include financial barriers, limited availability of services, and geographic concentration in cities. Women were shown to access residential and inpatient SUD treatment at lower rates than men, and certain racial groups face unique language and financial barriers in accessing services. Studies indicate mixed success of inpatient and residential SUD treatment in sustained SUD remission for patients. CONCLUSION There are significant gaps in the literature, driven by a lack of longitudinal studies focused on patient outcomes following treatment and the use of a narrow definition of treatment success. Both structural and non-structural barriers, such as stigma and discrimination, are barriers to access. Further research is needed to evaluate approaches to mitigate these barriers and expand access to residential and inpatient SUD treatment.
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Affiliation(s)
- Samuel Janson
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
| | - Lily Nyenga
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Haneefa Saleem
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Stella E Mushy
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Masunga K Iseselo
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Jenna van Draanen
- University of Washington School of Public Health, Seattle, Washington, USA
- University of Washington School of Nursing, Seattle, Washington, USA
| | - Joseph Tucker
- University of North Carolina School of Medicine, Chapell Hill, North Carolina, USA
| | - Mecca McPherson
- Temple University College of Public Health, Philadelphia, PA, USA
| | - Donaldson F Conserve
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
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Iversen HH, Haugum M, Ellingsen-Dalskau LH, Bjertnaes O. Reliability and validity of the Patient Experiences Questionnaire for Interdisciplinary Treatment for Substance Dependence - Continuous Electronic Measurement (PEQ-ITSD - CEM). BMC Health Serv Res 2024; 24:26. [PMID: 38178069 PMCID: PMC10768463 DOI: 10.1186/s12913-023-10506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Inpatient experiences with interdisciplinary treatment for substance dependence and mental health care are measured using continuous electronic measurements in Norway. Major changes in data collection from cross-sectional surveys to continuous measurements necessitated the revalidation of the instrument. The main purpose of the present study was to determine the psychometric properties of the Patient Experiences Questionnaire for Interdisciplinary Treatment for Substance Dependence - Continuous Electronic Measurement (PEQ-ITSD - CEM). We also aimed to develop a short version of this tool, since completing the original version can be burdensome for some patients. METHODS The study included adult inpatients (aged ≥ 16 years) who received substance-dependence treatment at 102 different sections in Norway during 2020-2022 (n = 2,850). Factor structure and item performance were assessed. A short version was developed based on the psychometric testing results that included item response theory analysis. RESULTS The PEQ-ITSD - CEM comprised three empirically based scales with good internal consistency, reliability and validity, which covers treatment and personnel (14 items), milieu (6 items) and outcome (5 items). The results supported a seven-item short version, with three items selected for the treatment and personnel scale, two items for the milieu scale and two items for the outcome scale. CONCLUSIONS The PEQ-ITSD - CEM can be recommended for future assessments of patient experiences with interdisciplinary treatment for substance dependence in Norway and in other countries with similar healthcare systems. This short-form version can be applied when respondent burden is a crucial issue.
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Affiliation(s)
| | - Mona Haugum
- Norwegian Institute of Public Health, PO Box 222 Skoyen, Oslo, 0213, Norway
| | | | - Oyvind Bjertnaes
- Norwegian Institute of Public Health, PO Box 222 Skoyen, Oslo, 0213, Norway
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Paschen-Wolff MM, DeSousa A, Paine EA, Hughes TL, Campbell ANC. Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs. Subst Abuse Treat Prev Policy 2024; 19:2. [PMID: 38172902 PMCID: PMC10765665 DOI: 10.1186/s13011-023-00581-8] [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: 08/28/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this exploratory qualitative descriptive study was to characterize LGBTQ+ people's experiences in SU services and recommendations for LGBTQ+- affirming care. METHODS We conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ+ people. We employed flexible coding and a thematic analysis approach to describe participants' experiences with stigma, discrimination, and support within SU services at the patient-, staff-, and organizational-level; and participant recommendations for how to make such services LGBTQ+-affirming. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis. RESULTS Patient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ+ peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants' sexuality; and support via staff advocacy for LGBTQ+ patients, holistic treatment models, and openly LGBTQ+ staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, LGBTQ+-specific programming, hiring LGBTQ+ staff, routine staff sensitivity training, and gender-inclusive program structures. CONCLUSIONS LGBTQ+ people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.
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Affiliation(s)
- Margaret M Paschen-Wolff
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Avery DeSousa
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Emily Allen Paine
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, 560 W. 168th Street, New York, NY, 10032, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
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Honan LE, Fraser-Spears R, Daws LC. Organic cation transporters in psychiatric and substance use disorders. Pharmacol Ther 2024; 253:108574. [PMID: 38072333 PMCID: PMC11052553 DOI: 10.1016/j.pharmthera.2023.108574] [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: 10/06/2023] [Revised: 11/01/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
Psychiatric and substance use disorders inflict major public health burdens worldwide. Their widespread burden is compounded by a dearth of effective treatments, underscoring a dire need to uncover novel therapeutic targets. In this review, we summarize the literature implicating organic cation transporters (OCTs), including three subtypes of OCTs (OCT1, OCT2, and OCT3) and the plasma membrane monoamine transporter (PMAT), in the neurobiology of psychiatric and substance use disorders with an emphasis on mood and anxiety disorders, alcohol use disorder, and psychostimulant use disorder. OCTs transport monoamines with a low affinity but high capacity, situating them to play a central role in regulating monoamine homeostasis. Preclinical evidence discussed here suggests that OCTs may serve as promising targets for treatment of psychiatric and substance use disorders and encourage future research into their therapeutic potential.
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Affiliation(s)
- Lauren E Honan
- The University of Texas Health Science Center at San Antonio, Department of Cellular & Integrative Physiology, USA
| | - Rheaclare Fraser-Spears
- University of the Incarnate Word, Feik School of Pharmacy, Department of Pharmaceutical Sciences, USA
| | - Lynette C Daws
- The University of Texas Health Science Center at San Antonio, Department of Cellular & Integrative Physiology, USA; The University of Texas Health Science Center at San Antonio, Department of Pharmacology, USA.
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Cabral DAR, Rego MLM, Fontes EB, Tavares VDO. An overlooked relationship in recovery from substance use disorders: Associations between body mass index and negative emotional states. Physiol Behav 2024; 273:114383. [PMID: 37866643 DOI: 10.1016/j.physbeh.2023.114383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
Recovery from substance use disorders (SUD) is multifactorial. Being overweight could negatively impact physiological and psychological health-related parameters. Using model selection, we examined associations between body mass index (BMI) and negative emotional states (NES; e.g., stress, anxiety, depression) in 54 men with SUD and under treatment in five different therapeutic recovery centers. We found that BMI was positively associated with stress (p < .001), anxiety (p < .001), and depression (p = .002). Therefore, our findings suggest that decreasing the accumulation of body fat might contribute to improving mental health in individuals with SUD during recovery.
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Affiliation(s)
- Daniel A R Cabral
- Fralin Biomedical Research Institute at Virginia Tech Carilion, 2 Riverside Circle, Roanoke, VA 24016, USA.
| | - Maria L M Rego
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Eduardo B Fontes
- Department of Health Sciences, Stonehill College, Easton, MA, USA; Department of Physical Education, Federal University of Paraná, Curitiba, Brazil
| | - Vagner D O Tavares
- Laboratory of Hormone Measurement, Department of Physiology and Behavior, Federal University of Rio Grande do Norte, Natal, Brazil
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Lindner SR, Scarpa S, McCarty D, Lundgren L. Addiction severity and re-employment in Sweden among adults with risky alcohol and drug use. J Subst Use Addict Treat 2024; 156:209178. [PMID: 37820868 DOI: 10.1016/j.josat.2023.209178] [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] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/19/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The Addiction Severity Index (ASI) assesses respondents' biopsychosocial problems in seven addiction-related domains (mental health, family and social relations, employment, alcohol use, drug use, physical health, and legal problems). This study examined the association between the seven ASI composite scores and re-employment in a sample of Swedish adults screened for risky alcohol and drug use who were without employment at assessment. METHODS We conducted a retrospective cohort analysis of employment outcomes among 6502 unemployed adults living in Sweden who completed an ASI assessment for risky alcohol and drug use. The study linked ASI scores to annual tax register data. The primary outcome was employment, defined as having earnings above an administrative threshold. We used Cox proportional hazard models to estimate the association between time to re-employment and ASI composite scores, controlling for demographic characteristics, RESULTS: Approximately three in ten individuals in the sample regained employment within five years. ASI composite scores suggested widespread biopsychosocial problems. Re-employment was associated with lower ASI composite scores for mental health (estimate: 0.775, 95 % confidence interval: 0.629-0.956), employment (estimate: 0.669, confidence interval: 0.532-0.841), drug use (estimate: 0.628, confidence interval: 0.428-0.924), and health (estimate: 0.798, confidence interval: 0.699-0.912). CONCLUSIONS This study suggests that several ASI domains may provide information on the complex factors (i.e., mental health, health, drug use) associated with long-term unemployment for people with risky substance use.
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Affiliation(s)
- Stephan R Lindner
- Center for Health Systems Effectiveness (CHSE), Oregon Health & Science University, 3030 SW Moody Ave, Portland, OR 97201, United States; OHSU-PSU School of Public Health, 1805 SW Fourth Ave, Portland, OR 97201, United States.
| | - Simone Scarpa
- Department of Social Work, Umeå University, Samhällsvetarhuset, 901 87 Umeå, Sweden.
| | - Dennis McCarty
- OHSU-PSU School of Public Health, 1805 SW Fourth Ave, Portland, OR 97201, United States; Division of General and Internal Medicine, School of Medicine, Oregon Health & Science University, 3266 SW Research Drive, Portland, OR 97239, United States.
| | - Lena Lundgren
- Department of Social Work, Umeå University, Samhällsvetarhuset, 901 87 Umeå, Sweden; Cross-National Behavioral Health Laboratory, University of Denver, 2148 S High Street, Denver, CO 80208, United States.
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Ali F, Law J, Russell C, Bozinoff N, Rush B. An environmental scan of residential treatment service provision in Ontario. Subst Abuse Treat Prev Policy 2023; 18:73. [PMID: 38087331 PMCID: PMC10717570 DOI: 10.1186/s13011-023-00586-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Ontario has one of the highest rates of substance-related harms in Canada. Residential treatment programs in the province provide a variety of in-house treatment services to support the needs of individuals with substance use disorders (SUD). However, these programs are not standardized, often varying in the type, quality, and availability of services offered, including evidence-based interventions such as Opioid Agonist Treatment (OAT). Local treatment systems are also rather fragmented and complex to navigate, creating barriers for potential services users to identify and make informed choices on available treatment options. METHODS Between May to August 2023, we conducted an environmental scan to capture available information on all publicly-funded residential treatment programs in Ontario using the ConnexOntario service portal, a government-funded, health services information platform. Data were captured on organization name, geographical location, program description, program type (residential addictions treatment or supportive recovery programs), eligibility criteria, target population, the program's OAT policies, number of available beds, minimum and maximum length of stay, projected wait times, funding source, and associated fees for program admission. Data were extracted and organized by geographic region, and findings were presented descriptively. RESULTS A total of 102 residential addiction treatment programs and 36 residential supportive recovery programs in Ontario were identified. The scan noted substantial regional variations in program availability and wait times, along with a lack of programs tailored to unique populations such as women, youth, and Indigenous peoples. There is also a paucity of publicly-available information on program offerings, including detailed specifics on OAT policies within residential treatment programs that are crucial to ensuring that the services being offered are safe and grounded in evidence-based practice. CONCLUSIONS Findings from the scan highlight notable gaps in program types, offerings, and availability among residential treatment programs in the province, including a lack of standardization on OAT policies across programs. Efforts should be made to ensure access to treatment-specific program information relevant to potential service users and to enhance coordinated access to residential treatment services in the province.
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Affiliation(s)
- Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, Ontario, M5S 2S1, Canada.
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, Ontario, M5S 2S1, Canada.
| | - Justine Law
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, Ontario, M5S 2S1, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, Ontario, M5S 2S1, Canada
| | - Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, Ontario, M5S 2S1, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, Ontario, M5S 2S1, Canada
| | - Nikki Bozinoff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian Rush
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, Ontario, M5S 2S1, Canada
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Morin KA, Ghartey K, Bodson A, Sirois A, Leary T. Evaluating an addiction medicine unit in Sudbury, Ontario Canada: a mixed-methods study protocol. BMC Health Serv Res 2023; 23:1366. [PMID: 38057899 DOI: 10.1186/s12913-023-10313-0] [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: 09/21/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND In response to the escalating global prevalence of substance use and the specific challenges faced in Northern Ontario, Canada, an Addiction Medicine Unit (AMU) was established at Health Sciences North (HSN) in Sudbury. This protocol outlines the approach for a comprehensive evaluation of the AMU, with the aim of assessing its impact on patient outcomes, healthcare utilization, and staff perspectives. METHODS We conducted a parallel mixed-method study that encompassed the analysis of single-center-level administrative health data and primary data collection, including a longitudinal observational study (target n = 1,200), pre- and post-admission quantitative interviews (target n = 100), and qualitative interviews (target n = 25 patients and n = 15 staff). We implemented a participatory approach to this evaluation, collaborating with individuals who possess lived or living expertise in drug use, frontline staff, and decision-makers across the hospital. Data analysis methods encompass a range of statistical techniques, including logistic regression models, Cox proportional hazards models, Kaplan-Meier curves, Generalized Estimating Equations (GEE), and thematic qualitative analysis, ensuring a robust evaluation of patient outcomes and healthcare utilization. DISCUSSION This protocol serves as the foundation for a comprehensive assessment designed to provide insights into the AMU's effectiveness in addressing substance use-related challenges, reducing healthcare disparities, and improving patient outcomes. All study procedures have been meticulously designed to align with the ethical principles outlined in the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. The findings will be disseminated progressively through committees and working groups established for this research, and subsequently published in peer-reviewed journals. Anticipated outcomes include informing evidence-based healthcare decision-making and driving improvements in addiction treatment practices within healthcare settings.
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Affiliation(s)
- Kristen A Morin
- Health Sciences North, Sudbury, ON, Canada.
- ICES North (Institute for Clinical and Evaluative Sciences), Sudbury, ON, Canada.
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.
| | - Karla Ghartey
- University of Toronto, Toronto, ON, Canada
- Cambrian College, Sudbury, ON, Canada
| | | | - Alexandra Sirois
- Health Sciences North, Sudbury, ON, Canada
- Laurentian University, Sudbury, ON, Canada
| | - Tara Leary
- Health Sciences North, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
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Lee AY, Lehmann C, Zhou P, Xie B, Reynolds KD, Stacy AW. A quantitative survey measure of moral evaluations of patient substance misuse among health professionals in California, urban France, and urban China. Philos Ethics Humanit Med 2023; 18:18. [PMID: 38049902 PMCID: PMC10696895 DOI: 10.1186/s13010-023-00148-2] [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: 05/10/2022] [Accepted: 11/11/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The merits and drawbacks of moral relevance models of addiction have predominantly been discussed theoretically, without empirical evidence of these potential effects. This study develops and evaluates a novel survey measure for assessing moral evaluations of patient substance misuse (ME-PSM). METHODS This measure was tested on 524 health professionals (i.e., physicians, nurses, and other health professionals) in California (n = 173), urban France (n = 102), and urban China (n = 249). Demographic factors associated with ME-PSM were investigated using analyses of variance (ANOVAs) and t-tests, with results suggesting that ME-PSM is higher among younger health professionals, nurses (when compared with physicians and other health professionals), and Chinese health professionals (when compared with French and American health professionals). RESULTS Results provide preliminary support for the psychometric quality of the survey measure introduced in this study, including the existence of a single latent structure and partial invariance of collected data across countries. CONCLUSION The survey measure for ME-PSM which was developed and tested in the current study appears to hold potential utility for use as a measure of moral views of patient substance misuse. With development, this measure may be used to examine moral evaluations, both as factors of stigma and of other clinical factors associated with the treatment of patients with substance use disorders.
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Affiliation(s)
- Anna Yu Lee
- School of Community & Global Health, Claremont Graduate University, 150 E. 10th St, Claremont, CA, 91711, USA.
| | - Curtis Lehmann
- Department of Psychology, Azusa Pacific University, 901 E. Alosta Ave., Azusa, CA, 91702, USA
| | - Pengchong Zhou
- Department of Public Health, California State University Los Angeles, 5151 State University Drive, Los Angeles, CA, 90032, USA
| | - Bin Xie
- School of Community & Global Health, Claremont Graduate University, 150 E. 10th St, Claremont, CA, 91711, USA
| | - Kim D Reynolds
- School of Community & Global Health, Claremont Graduate University, 150 E. 10th St, Claremont, CA, 91711, USA
| | - Alan W Stacy
- School of Community & Global Health, Claremont Graduate University, 150 E. 10th St, Claremont, CA, 91711, USA
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Riggs P. A Pragmatic Clinical Approach to Substance Abuse Prevention. Psychiatr Clin North Am 2023; 46:741-748. [PMID: 37879835 DOI: 10.1016/j.psc.2023.03.002] [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] [Indexed: 10/27/2023]
Abstract
Research has led to the development of hundreds of evidence-based prevention interventions, most of which are school-based prevention programs. Most primary care clinicians and child/adolescent behavioral health clinicians are unfamiliar with and/or lack training in evidence-based prevention interventions. However, most clinicians in these settings routinely screen children for developmental delays and skills deficits that increase the risk of developing substance abuse and a broad range of mental health and behavior problems by adolescence. It is hoped that the broader use of these practical evidence-based prevention tools may expand the prevention workforce to address the current youth mental health crisis.
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Affiliation(s)
- Paula Riggs
- Division of Addiction Science, Prevention & Treatment, Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building (AHSB), 1890 N Revere Court, Aurora, CO 80045, USA.
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Le Bozec M, Tebeka S, Dubertret C, Sleurs D, Mhanna E, Le Strat Y. The association of stroke with mental and physical disorders in US adults: A nationally representative study. J Psychiatr Res 2023; 168:45-51. [PMID: 37897836 DOI: 10.1016/j.jpsychires.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/05/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
Stroke has been linked to various physical and mental disorders, with both stroke and its comorbidities significantly impacting public health. In this population-based study, we evaluate the relationships between stroke, physical conditions, mental disorders, and their effect on quality of life. Data were gathered from a nationally representative sample of 36,309 civilian participants aged 18 years and older in the National Epidemiologic Survey on Alcohol and Related Conditions-III. We examined the prevalence of past-year stroke, its sociodemographic characteristics, and its associations with past-year mental disorders (according to the DSM-5) and physical conditions. Furthermore, we explored the connections between stroke and health-related quality of life, accounting for comorbidities. The past 12-month stroke prevalence was estimated at 0.82%. Participants with stroke exhibited a significantly higher past 12-month mental disorder prevalence than those without stroke. Specifically, individuals with stroke faced a higher risk of mood disorders, anxiety disorders, tobacco use disorder, and opioid use disorder compared to those without stroke. Stroke was also positively associated with 24 out of the 27 physical conditions assessed in this study. Participants with stroke experienced lower mental and physical quality of life compared to those without stroke. Stroke was significantly related to numerous mental and physical disorders. The association of stroke with diminished health-related quality of life was not only mediated by these comorbidities but should also be considered as inherently linked to stroke itself.
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Affiliation(s)
- Manon Le Bozec
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, F-75014, Paris, France; Department of Neurology and Psychogeriatrics, Leopold Bellan Hospital, Paris, France.
| | - Sarah Tebeka
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, F-75014, Paris, France; Department of Neurology and Psychogeriatrics, Leopold Bellan Hospital, Paris, France
| | - Caroline Dubertret
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, F-75014, Paris, France; Department of Neurology and Psychogeriatrics, Leopold Bellan Hospital, Paris, France
| | - David Sleurs
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, F-75014, Paris, France; Department of Neurology and Psychogeriatrics, Leopold Bellan Hospital, Paris, France
| | - Elsa Mhanna
- Department of Neurology and Psychogeriatrics, Leopold Bellan Hospital, Paris, France
| | - Yann Le Strat
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France; Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, F-75014, Paris, France; Department of Neurology and Psychogeriatrics, Leopold Bellan Hospital, Paris, France
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Hopkins JL, Goldsmith ST, Wood SK, Nelson KH, Carter JS, Freels DL, Lewandowski SI, Siemsen BM, Denton AR, Scofield MD, Reichel CM. Perirhinal to prefrontal circuit in methamphetamine induced recognition memory deficits. Neuropharmacology 2023; 240:109711. [PMID: 37673333 PMCID: PMC10591958 DOI: 10.1016/j.neuropharm.2023.109711] [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: 06/02/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
Return to methamphetamine (meth) use is part of an overarching addictive disorder hallmarked by cognitive sequela and cortical dysfunction in individuals who use meth chronically. In rats, long access meth self-administration produces object recognition memory deficits due to drug-induced plasticity within the perirhinal cortex (PRH). PRH projections are numerous and include the medial prefrontal cortex (mPFC). To evaluate the role of the PRH-mPFC reciprocal circuit in novel object recognition memory, a rgAAV encoding GFP-tagged Cre recombinase was infused into the PRH or the mPFC and rats were tested for recognition memory. On test day, one group explored both familiar and novel objects. A second group explored only familiar objects. GFP and Fos expression were visualized in the mPFC or PRH. During exploration, PRH neurons receiving input from the mPFC were equally activated by exploration of novel and familiar objects. In contrast, PRH neurons that provide input to the mPFC were disproportionately activated by novel objects. Further, the percent of Fos + cells in the PRH positively correlated with recognition memory. As such, the flow of communication appears to be from the PRH to the mPFC. In agreement with this proposed directionality, chemogenetic inhibition of the PRH-mPFC circuit impaired object recognition memory, whereas chemogenetic activation in animals with a history of long access meth self-administration reversed the meth-induced recognition memory deficit. This finding informs future work aimed at understanding the role of the PRH, mPFC, and their connectivity in meth associated memory deficits. These data suggest a more complex circuitry governing recognition memory than previously indicated with anatomical or lesion studies.
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Affiliation(s)
- Jordan L Hopkins
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA
| | - Sarah T Goldsmith
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA
| | - Samuel K Wood
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA
| | - Katharine H Nelson
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA
| | - Jordan S Carter
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA
| | - Dylan L Freels
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA
| | - Stacia I Lewandowski
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA
| | - Benjamin M Siemsen
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA
| | - Adam R Denton
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA
| | - Michael D Scofield
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA
| | - Carmela M Reichel
- Reichel Laboratory, Medical University of South Carolina, Department of Neuroscience, Charleston, SC, 29425, USA.
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Arazi T, Mohammadi S, Movahedi A, Aryaee Far MR, Moeini V. Barriers to providing quality care for patients with substance use disorders from the perspective of baccalaureate nursing students: A descriptive qualitative study. Nurse Educ Today 2023; 131:105961. [PMID: 37688943 DOI: 10.1016/j.nedt.2023.105961] [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] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND With Iran facing an epidemic in substance use disorders, nursing students are increasingly encountering people impacted by substance misuse. Providing care for this group brings with it many barriers and challenges. These serious barriers have not been a priority in Iranian nurse education. OBJECTIVES To describe barriers to providing quality care for people with substance use disorders from the perspective of nursing students. DESIGN A descriptive qualitative study, using content analysis was used to address the study aim. SETTING AND PARTICIPANTS Purposive sampling was used to recruit participants. Participants were 34 baccalaureate nursing students from different academic semesters studying at two medical sciences universities in Iran. METHODS Data were collected using semi-structured interviews from July 2022 to October 2022. Granheim & Lundman's method for qualitative content analysis was used to analyze data. RESULTS The barriers to providing quality care for people with substance use disorders were described through the major theme: "lack of communication skills and difficulty finding language for therapeutic communication with people with substance use disorders". Based on nursing student perspectives, a lack of communication and language for therapeutic communication was described through the three barriers of: 1. "possessing or witnessing prejudiced attitudes and stereotypes", 2 "negative role models", and 3. "Knowledge deficit in self or others". CONCLUSION The result of this study showed that nursing students interact with people with substance use disorders through prejudiced attitudes, negative stereotypes, and knowledge deficits. Academic education should include practical techniques to reduce negative stereotypes and moral distress among nursing students as well as strategies to manage tough ethical situations and decrease prejudiced attitudes. Nurses and clinical educators must be attentive to their power to influence nursing students and should model appropriate unbiased behavior and language.
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Affiliation(s)
- Tajmohammad Arazi
- Department of Nursing and Operating Room, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Sepideh Mohammadi
- Department of Nursing, Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Ali Movahedi
- Department of Anesthesia Nursing, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | | | - Vahid Moeini
- Department of Operating Room, Neyshabur University of Medical Sciences, Neyshabur, Iran
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Berro LF. Insomnia as a Risk Factor for Substance Use Disorders in Women. Sleep Med Clin 2023; 18:511-520. [PMID: 38501523 PMCID: PMC10950003 DOI: 10.1016/j.jsmc.2023.06.010] [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: 03/20/2024]
Abstract
Gender differences exist for both insomnia and substance use disorders. Women show a higher prevalence of insomnia and increased susceptibility to the effects of drugs than men. Importantly, a growing body of evidence suggests that insufficient sleep predicts and puts individuals at a higher risk for substance use and associated psychosocial problems. However, the role of insomnia in substance use disorders among women remains poorly understood. The present article discusses gender differences in insomnia and in substance use disorders and reviews evidence suggesting that an increased prevalence of insomnia may be a risk factor for substance use disorders in women.
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Affiliation(s)
- Laís F Berro
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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Campbell ANC, Rieckmann T, Pavlicova M, Choo TH, Molina K, McDonell M, West AE, Daw R, Marsch LA, Venner KL. Culturally tailored digital therapeutic for substance use disorders with urban Indigenous people in the United States: A randomized controlled study. J Subst Use Addict Treat 2023; 155:209159. [PMID: 37690525 PMCID: PMC10872747 DOI: 10.1016/j.josat.2023.209159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/15/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Indigenous people experience health disparities, including higher rates of substance use disorders (SUDs). Digital therapeutics are a growing platform for treatment services and have the potential to expand access to culturally responsive interventions for Indigenous people. As one of the first randomized controlled trials for SUDs for American Indian and Alaska Native (AI/AN) adults, the aim of this study was to pilot test the efficacy of a culturally tailored intervention among urban Indigenous adults. METHODS The study used a randomized controlled parallel design of 12 weeks of treatment-as-usual (TAU) (n = 26) versus TAU + Therapeutic Education System-Native Version (TES-NAV) (n = 27) with follow-up assessments at end of treatment and week 24 in an urban outpatient addiction treatment program for Native American adults. TAU consisted of individual/group counseling and cultural activities. The TES-NAV arm comprised TAU + 26 self-directed culturally tailored digital skills-based modules grounded in the community reinforcement approach with contingency management for abstinence and module completion. Primary outcome was longest consecutive weeks of abstinence from drugs and heavy drinking measured using self-report (Timeline Followback) and urine alcohol and drug toxicology screen during 12 weeks of treatment. Secondary outcomes were percent days abstinence during and posttreatment, coping strategies, social connectedness, and substance use and sexual risk behaviors. RESULTS The study enrolled fifty-three (52.8 % male) AI/AN adults seeking treatment for a SUD. Although the study did not detect a benefit of TAU+TES-NAV over TAU on the primary outcome (Median = 2 consecutive weeks of abstinence for both arms) at end of treatment (treatment effect: Z = -0.78, p = 0.437), TAU+TES-NAV participants did demonstrate significantly greater percent days of abstinence at the week 24 follow-up (69.3 % versus 49.0 % for TAU; t = 2.08, p = 0.045) and significantly greater change in social connectedness mean score, baseline to week 12 (Z = -2.66, p = 0.011), compared to TAU. The study detected no differences between treatment arms for coping strategies or risk behaviors. CONCLUSION The addition of TES-NAV to TAU did not significantly improve consecutive weeks of abstinence from drugs or heavy drinking; however, several secondary findings suggest promise for a culturally tailored digital therapeutic SUD intervention among urban Indigenous people. CLINICAL TRIALS GOV REGISTRATION: #NCT03363256.
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Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA.
| | - Traci Rieckmann
- School of Medicine, Oregon Health & Science University, 3015 NE 44th Ave, Portland, OR 97213, USA
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168th St, 6th floor, Room 635, New York, NY 10032, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive Box 120, New York, NY 10032, USA
| | - Kelly Molina
- Native American Rehabilitation Association of the Northwest, Inc., 1631 SW Columbia St, Portland, OR 97201, USA
| | - Michael McDonell
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA 99202, USA
| | - Amy E West
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4640 W. Sunset Blvd, Los Angeles, CA 90027, USA
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Kamilla L Venner
- Department of Psychology and Center on Alcohol Substance use & Addiction (CASAA), University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA
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Wolitzky-Taylor K. Integrated behavioral treatments for comorbid anxiety and substance use disorders: A model for understanding integrated treatment approaches and meta-analysis to evaluate their efficacy. Drug Alcohol Depend 2023; 253:110990. [PMID: 37866006 DOI: 10.1016/j.drugalcdep.2023.110990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Substance use disorders (SUD) and anxiety disorders are highly comorbid, and this comorbidity is associated with poor clinical outcomes. Emerging research in the last decade has shifted from addressing these problems separately to the development and evaluation of behavioral treatments that integrate care for anxiety disorders (or elevated symptoms of anxiety) and SUD. METHODS An extensive literature search revealed a sufficient number of studies (K=11) to conduct a meta-analysis comparing the efficacy of integrated SUD/anxiety disorder behavioral treatment to SUD treatment alone on substance use and anxiety symptom outcomes. Randomized clinical trials including those with SUD and either anxiety disorders or elevations in constructs implicated in the maintenance of anxiety disorder/SUD comorbidity were included. This study meta-analyzes the effects of these studies. RESULTS Integrated treatments outperformed SUD treatments alone on both substance use and anxiety outcomes, with small to moderate effects favoring integrated treatments. There was no significant heterogeneity across studies in the primary analyses, such that moderator analyses to identify variables that yielded differential patterns of effect sizes were not conducted. DISCUSSION Integrated treatments for SUD/anxiety disorders demonstrate an incremental but significant and clinically meaningful improvement over SUD treatment alone for SUD/anxiety disorder comorbidity. Implications for future research and clinical practice paradigm shifting are discussed.
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Aber-Odonga H, Nuwaha F, Kisaakye E, Engebretsen IMS, Babirye JN. Health facility readiness to screen, diagnose and manage substance use disorders in Mbale district, Uganda. Subst Abuse Treat Prev Policy 2023; 18:63. [PMID: 37925411 PMCID: PMC10625191 DOI: 10.1186/s13011-023-00570-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: 07/25/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Substance use disorders (SUD) pose a significant public health problem in Uganda. Studies indicate that integrating mental health services into Primary Health Care can play a crucial role in alleviating the impact of SUD. However, despite ongoing efforts to integrate these services in Uganda, there is a lack of evidence regarding the preparedness of health facilities to effectively screen and manage SUD. Therefore, this study aimed to assess the readiness of health facilities at all levels of the health system in Mbale, Uganda, to carry out screening, diagnosis, and management of SUD. METHODS A health facility-based cross-sectional study was carried out among all the 54 facilities in Mbale district. A composite variable adapted from the WHO Service Availability and Readiness Assessment manual (2015) with 14 tracer indicators were used to measure readiness. A cut-off threshold of having at least half the criteria fulfilled (higher than the cutoff of 7) was classified as having met the readiness criteria. Descriptive analyses were performed to describe readiness scores across various facility characteristics and a linear regression model was used to identify the predictors of readiness. RESULTS Among all health facilities assessed, only 35% met the readiness criteria for managing Substance Use Disorders (SUD). Out of the 54 facilities, 42 (77.8%) had guidelines in place for managing SUD, but less than half, 26 (48%), reported following these guidelines. Only 8 out of 54 (14.5%) facilities had staff who had received training in the diagnosis and management of SUD within the past two years. Diagnostic tests for SUD, specifically the Uri stick, were available in the majority of facilities, (46/54, 83.6%). A higher number of clinical officers working at the health centres was associated with higher readiness scores (score coefficient 4.0,95% CI 1.5-6.5). CONCLUSIONS In this setting, a low level of health facility readiness to provide screening, diagnosis, and management for substance use disorders was found. To improve health facility readiness for delivery of care for substance use disorders, a frequent inventory of human resources in terms of numbers, skills, and other resources are required in this resource-limited setting.
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Affiliation(s)
- Harriet Aber-Odonga
- School of Public Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda.
| | - Fred Nuwaha
- School of Public Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Esther Kisaakye
- School of Public Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
| | - Ingunn Marie S Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, 7804, Norway
| | - Juliet Ndimwibo Babirye
- School of Public Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda
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Lee YK, Trevisan L, S Fuehrlein B. Longitudinal Outcomes of the top 20 Utilizers of VA Connecticut's Psychiatric Emergency Services Between 2010 and 2020. Community Ment Health J 2023; 59:1532-1536. [PMID: 37243739 DOI: 10.1007/s10597-023-01140-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
Frequent utilizers of emergency services represent a clinically important cohort with potentially unmet health care needs despite demanding a high volume of costly services. However, not much is known about their longitudinal course. This study identified the top 20 utilizers of VA Connecticut's psychiatric emergency services and conducted a chart review of their longitudinal outcomes during an 11-year period between 2010 and 2020, including their visit diagnoses, medical and psychiatric comorbidities, and types and frequency of other medical services and supports received. At the index visit, 19 of the 20 patients had substance use disorder and 14 patients had at least one non-substance psychiatric diagnosis. Despite all patients receiving primary care and other services, such as residential treatments, outpatient therapy, and social work consults, 11 of the 12 patients remaining alive and residing in the state continued to utilize psychiatric emergency services in 2020, revealing a pattern of persistent use.
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Affiliation(s)
- Yu Kyung Lee
- Yale School of Medicine, Yale University School of Medicine, New Haven, USA.
| | - Louis Trevisan
- Yale School of Medicine, Yale University School of Medicine, New Haven, USA
- Department of Psychiatry, Creighton University, Omaha, USA
| | - Brian S Fuehrlein
- Yale School of Medicine, Yale University School of Medicine, New Haven, USA
- Department of Psychiatry, Yale University, New Haven, USA
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Fitzsimons MG, de Sousa GS, Galstyan A, Quintão VC, Simões CM. Prevention of drug diversion and substance use disorders among anesthesiologists: a narrative review. Braz J Anesthesiol 2023; 73:810-818. [PMID: 37517585 PMCID: PMC10625155 DOI: 10.1016/j.bjane.2023.07.008] [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] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers.
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Affiliation(s)
- Michael G Fitzsimons
- Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, USA
| | - Gabriel Soares de Sousa
- Hospital Sírio-Libanês, Serviços Médicos de Anestesia (SMA), São Paulo, SP, Brazil; Hospital Municipal Infantil Menino Jesus, Serviços Médicos de Anestesia (SMA), São Paulo, SP, Brazil
| | - Arpine Galstyan
- Massachusetts General Hospital, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, USA
| | - Vinícius Caldeira Quintão
- Universidade de São Paulo, Faculdade de Medicina, Disciplina de Anestesiologia, São Paulo, SP, Brazil.
| | - Cláudia Marquez Simões
- Hospital Sírio-Libanês, Serviços Médicos de Anestesia (SMA), São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Disciplina de Anestesiologia, São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), Hospital das Clínicas (HC), Instituto do Câncer do Estado de São Paulo ICESP, São Paulo, SP, Brazil
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