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This study examined the role of parenthood and parental influences on substance use patterns for 710 stimulant users age 18–61 living in the rural Midwest and Mid‐south U.S. Longitudinal growth analyses showed that a maternal history of drug use was associated with increased baseline drug use severity, lesser declines in severity, and greater plateau of drug use severity over time. Parental conflict was associated with lesser declines in drug use severity, and drug use severity declined more steeply for participants who were themselves parents. Participants with two parents having a history of alcohol use had a greater baseline severity of alcohol use, with paternal history of drug use associated with lower baseline alcohol use severity. These findings demonstrate the importance of identifying parental influences in evaluating adult substance use, and point to the inclusion of parents in efforts to prevent and treat substance use disorders. [ABSTRACT FROM AUTHOR]

Background: Negative views toward substance use treatment among some rural substance users and limited treatment resources in rural areas likely affect substance use utilization. It is therefore important to determine whether accessing healthcare options other than substance use treatment, specifically outpatient medical care (OMC), is associated with reductions in substance use.Objectives: We examined whether use of OMC was associated with reductions in substance use among rural substance users over a three-year period. We also explored whether substance user characteristics, including substance-use severity and related-problems, moderated this potential relationship.Methods: Data were collected from an observational study of 710 (61% male) stimulant users using respondent-driven sampling. Participants were recruited from rural counties of Arkansas, Kentucky, and Ohio.Results: We found a significant main effect of having at least one OMC visit (relative to none) on fewer days of alcohol, crack cocaine, and methamphetamine use over time. Fewer days of alcohol, crack cocaine, and methamphetamine use were reported in participants with at least one OMC visit (relative to those with none) among those reporting higher Addiction Severity Index employment and psychiatric severity scores, and low education, respectively.Conclusion: Our findings extend the results from prior studies with urban substance users to show that contact with an outpatient medical care clinic is associated with reductions in substance use over time among rural substance users with especially poorer functioning. These findings highlight the potential importance of OMCs in addressing unhealthy substance use in rural communities. [ABSTRACT FROM AUTHOR]

AimTo better understand barriers and facilitators that hinder or help women veterans discuss their alcohol use with providers in primary care in order to better identify problematic drinking and enhance provider–patient communication about harmful drinking.BackgroundWomen presenting to primary care may be less likely than men to disclose potentially harmful alcohol use. No studies have qualitatively examined the perspectives of primary care providers about factors that affect accurate disclosure of alcohol use by women veterans during routine clinic visits.MethodsProviders (n=14) were recruited from primary care at two veterans Administration Women’s Health Clinics in California, United States. An open-ended interview guide was developed from domains of the consolidated framework for implementation science. Interviews elicited primary care providers’ perspectives on barriers and facilitators to women veterans’ (who may or may not be using alcohol in harmful ways) disclosure of alcohol use during routine clinic visits. Interview data were analyzed deductively using a combination of template analysis and matrix analysis.FindingsParticipants reported six barriers and five facilitators that they perceived affect women veteran’s decision to accurately disclose alcohol use during screenings and openness to discussing harmful drinking with a primary care provider. The most commonly described barriers to disclosure were stigma, shame, and discomfort, and co-occuring mental health concerns, while building strong therapeutic relationships and using probes to ‘dig deeper’ were most often described as facilitators. Findings from this study may enhance provider–patient discussions about alcohol use and help primary care providers to better identify problematic drinking among women veterans, ultimately improving patient outcomes. [ABSTRACT FROM PUBLISHER]

This study's purpose was to identify distinct publishing trajectories among 442 participants in three prominent mentored health services research career development programs (Veterans Affairs, National Institutes of Health, and Agency for Healthcare Research & Quality) in the 10 years after award receipt and to examine awardee characteristics associated with different trajectories. Curricula vitae (CVs) of researchers receiving awards between 1991 and 2010 were coded for publications, grants, and awardee characteristics. We found that awardees published at constant or increasing rates despite flat or decreasing rates of first-author publications. Senior-author publications rose concurrently with rates of overall publications. Higher overall publication trajectories were associated with receiving more grants, more citations as measured by the h-index, and more authors per article. Lower trajectory groups were older and had a greater proportion of female awardees. Career development awards supported researchers who generally published successfully, but trajectories varied across individual researchers. Researchers' collaborative efforts produced an increasing number of articles, whereas first author articles were written at a more consistent rate. Career development awards in health services research supported the careers of researchers who published at a high rate; future research should further examine reasons for variation in publishing among early career researchers. [ABSTRACT FROM AUTHOR]

The article discusses a study of the retention in medication-assisted treatment among patients suffering from opiate dependence. Topics covered include the medication and behavioral therapy factors associated with retention, the difference in the retention rates of patients who received a placebo and those who were treated with naltrexone or buprenorphine, and the potential of contingency management to improve the retention.

AimThis article presents a conceptual model to help facilitate the transition from primary care to specialty substance use disorder (SUD) care for appropriate patients.BackgroundSubstance misuse is a common health condition among patients presenting to primary care settings and may complicate the treatment of chronic health conditions such as diabetes and hypertension. It is therefore critical that primary care providers be prepared to identify and determine appropriate treatment options for patients presenting with substance misuse.MethodsWe conducted a narrative review that occurred in three stages: literature review of health care transition models, identification of conceptual domains common across care transition models, and identification of SUD-specific model elements.FindingsThe conceptual model presented describes patient, provider, and system-level facilitators and barriers to the transition process, and includes intervention strategies that can be utilized by primary care clinics to potentially improve the process of transitioning patients from primary care to SUD care. Recognizing that primary care clinics vary in available resources, we present three examples of care practices along an intensity continuum from low (counseling and referral) to moderate (telephone monitoring) to high (intensive case management) resource demands for adoption. We also provide a list of common outcomes clinics might consider when evaluating the impact of care transition practices in this patient population; these include process outcomes such as patients’ increased knowledge of available treatment resources, and health outcomes such as patients’ reduced substance use and better quality of life. [ABSTRACT FROM AUTHOR]

Alcohol misuse and post-traumatic stress disorder (PTSD) are highly prevalent among veterans presenting to primary care. PTSD is associated with depression and increased substance use which can complicate the treatment of alcohol misuse. No studies have examined severity of depressive symptoms, rates and type of illicit drug use, and alcohol use severity in veterans with PTSD and alcohol misuse in primary care. Therefore, we examined (a) rates of PTSD and associated mental health comorbidities (depression, suicidal ideation), (b) current and lifetime illicit drug use and (c) alcohol use severity in relation to PTSD status in a sample of veterans presenting to primary care with alcohol misuse. We also tested the hypothesis that greater depressive symptoms, illicit drug use and alcohol use severity would be independently associated with greater likelihood of PTSD, after controlling for age and ethnicity. Veterans (N = 166) were recruited from primary care as part of an intervention study between the years 2010 and 2011. Veterans participating in the study completed an in-person semi-structured interview with study staff. Using the post-traumatic Stress Disorder Checklist-Military version, we found a 16.3% rate of PTSD. PTSD was associated with greater depressive symptoms, rates of suicidal ideation, alcohol use severity, current use of hypnotics and lifetime use of cocaine and amphetamines. Using logistic regression, we found that severity of depressive symptoms and lifetime cocaine use were independently associated with greater likelihood of PTSD, after controlling for age and ethnicity. Treatment implications of these findings are discussed. [ABSTRACT FROM PUBLISHER]

The Veterans Health Administration (VHA) has implemented initiatives to increase rates of brief alcohol counseling (BAC). Half of eligible veterans do not receive such care. Understanding patient characteristics associated with drinking behavior may identify patients for whom BAC may be acceptable. Data collected from veterans between January 2010 and September 2011 ( N = 167) were examined. Results find that alcohol-related concerns and perceptions of peer alcohol consumption are associated with reduced drinking behavior. These findings suggests that assessing drinking concerns and perceptions of peer alcohol use may help to identify patients interested in changing drinking behavior, receiving care, and assist providers in delivering appropriate counseling. [ABSTRACT FROM AUTHOR]

Background: This study included dyads comprised of adults entering treatment for alcohol use disorder and their Concerned Others (COs) to examine indicators of COs functioning (Al-Anon attendance and involvement, relationship stressors, use of approach coping and stigma) as predictors of patient outcomes (Alcoholics Anonymous (AA) attendance and involvement, abstinence and risk of substance use) over 12 months following adults' entry into AUD treatment.Methods: Dyads (n = 279) were assessed when patients entered treatment and at 3-, 6- and 12-month follow-ups. Data were collected through participants' self-report. Lagged generalized linear mixed models were used to examine associations between indicators of COs' functioning at baseline, 3- and 6-month follow-ups and patients' outcomes at 3-, 6- and 12-month follow-ups.Results: Patients reported less AA attendance and involvement and likelihood of maintaining abstinence from alcohol use over time. Findings from our multivariate analysis showed that any CO involvement in Al-Anon, relative to none, was associated with more patient AA attendance. In contrast, more stigma (e.g., need to hide patient's drinking) reported by COs was associated with lower patient AA participation and involvement, while more CO use of approach coping was associated with less patient risk for alcohol and drug use.Conclusions: Findings suggest that COs' functioning can affect longer-term outcomes of adults entering AUD treatment. Treatment programs should increase the availability of help to COs to improve their functioning and patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Long-term dependence on prescribed benzodiazepines is a public health problem. Eliminating Medications Through Patient Ownership of End Results (EMPOWER) is a promising self-management intervention, delivered directly to patients as a printed booklet, that is effective in promoting benzodiazepine reduction and cessation in older adults. EMPOWER has high potential to benefit large health care systems such as the US Veterans Health Administration (VHA), which cares for many veterans who use benzodiazepines for extended periods.Objective: We aimed to adapt the original EMPOWER booklet materials for electronic delivery and for use among US military veterans receiving VHA care who were long-term benzodiazepine users.Methods: We used elements of Analysis, Design, Development, Implementation, and Evaluation, a framework commonly used in the field of instructional design, to guide a qualitative approach to iteratively adapting EMPOWER Electronic Delivery (EMPOWER-ED). We conducted 3 waves of focus groups with the same 2 groups of VHA stakeholders. Stakeholders were VHA-enrolled veterans (n=16) with medical chart evidence of long-term benzodiazepine use and national VHA leaders (n=7) with expertise in setting VHA policy for prescription benzodiazepine use and developing electronically delivered educational tools for veterans. Qualitative data collected from each wave of focus groups were analyzed using template analysis.Results: Themes that emerged from the initial focus groups included veterans' anxiety about self-tapering from benzodiazepines and prior negative experiences attempting to self-taper without support. Participants also provided feedback on the protocol's look and feel, educational content, the tapering protocol, and website functionality; for example, feedback from policy leaders included listing, on the cover page, the most commonly prescribed benzodiazepines to ensure that veterans were aware of medications that qualify for self-taper using the EMPOWER-ED protocol. Both groups of stakeholders identified the importance of having access to supportive resources to help veterans manage sleep and anxiety in the absence of taking benzodiazepines. Both groups also emphasized the importance of ensuring that the self-taper could be personalized and that the taper instructions were clear. The policy leaders emphasized the importance of encouraging veterans to notify their provider of their decision to self-taper to help facilitate provider assistance, if needed, with the taper process and to help prevent medication stockpiling.Conclusions: EMPOWER-ED is the first direct-to-patient electronically delivered protocol designed to help US military veterans self-taper from long-term benzodiazepine use. We used the Analysis, Design, Development, Implementation, and Evaluation framework to guide the successful adaption of the original EMPOWER booklet for use with this population and for electronic delivery. The next step in this line of research is to evaluate EMPOWER-ED in a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Abstract: Background: Alcohol misuse occurs at high rates among U.S. Military Veterans presenting to primary care and is linked to numerous negative social and health consequences. The Veterans Health Administration has recently implemented brief alcohol interventions (BAI) in VA primary care settings. An emerging literature suggests that BAIs that target alcohol consumption may also have secondary health benefits such as reducing symptoms of depression and anxiety in civilian samples. The present study sought to examine whether secondary health benefits of BAIs observed in civilians generalize to a sample of alcohol misusing Veterans presenting to primary care. Methods: Veterans (N=167) screening positive for alcohol misuse during a routine primary care visit were randomized to receive treatment-as-usual (TAU) or TAU plus a web-delivered BAI. Assessment of overall mental health functioning, posttraumatic stress disorder, and depression occurred at baseline, three- and six-month post-treatment. Results: Veterans receiving both BAI protocols demonstrated significant improvements in mental health functioning, depressive symptoms, and use of approach coping from baseline to six-month follow-up. No differential treatment effects on these outcomes were observed. Limitations: Findings are limited by the lack of a no-treatment control group, and the potential impact of regression to the mean and assessment effects on outcomes. Conclusions: Our findings replicate prior studies suggesting that a single-dose BAI may have some secondary mental health benefits for Veterans presenting to primary care with alcohol misuse. [Copyright &y& Elsevier]

High voluntary turnover of substance abuse counsellors is a recognised and pervasive problem, likely due in large part to job-related burnout experienced by providers. This article explores the influence of the type of training on three facets of burnout (emotional exhaustion, depersonalisation and a reduced perception of personal accomplishments) among substance abuse counsellors participating in an online training protocol consisting of cognitive-behavioural therapy for substance use. Two training types were used: high fidelity (i.e. structured, didactic ''classroom''-style training), and low fidelity (i.e. more flexible and customisable training). Participation in a more flexible training model predicted lower burnout scores for participants both immediately and 6 months after training. Participants with a history of personal recovery from substance abuse and those working in positions of leadership also reported lower burnout scores after training. We conclude that perception of support and flexibility in the workplace may be helpful to prevent burnout and decrease existing burnout. [ABSTRACT FROM AUTHOR]