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Background: Overcoming addiction is characterized by a long-term recovery process and a high rate of relapse. This study aimed to identify factors associated with relapse and long-term abstinence in patients with substance use disorders or behavioral addictions (SUDs/BA) five years after completing the inpatient addiction treatment based on the Apolinar model. Methods: In this 5-year prospective cohort study, 366 (female 32.5%) patients with diagnosed SUDs/BA (ICD-10) who were treated between March 2004 and April 2008 in Czechia were studied. Data were collected using a non-standardized questionnaire and structured telephone interviews. Outcome measures were (i) relapse and (ii) long-term abstinence (at least one full year of continuous abstinence). Logistic regression was used to assess the effect of socio-demographic and treatment-related characteristics on outcome measures. Results: In a 5-year follow-up period, 70.2% of patients relapsed, while 46.7% relapsed within the first six months after completing the baseline treatment. Long-term abstinence was observed in 63.9% of patients. Of the treatment-related factors, early discontinuation of treatment, shorter treatment duration, and absence of early aftercare services predicted relapse in patients. A positive effect of early aftercare attendance on long-term abstinence was found. Conclusions: These findings support the importance of treatment compliance and aftercare to prevent relapse in addiction-treated patients. [ABSTRACT FROM AUTHOR]

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Background: Emergency department (ED) visits are an opportunity to provide prevention services to people at high risk of overdose. Considering patients' resources to initiate and sustain recovery ("recovery capital") may be useful for tailoring ED services, although its relevance in this population is unknown. Methods: This secondary analysis used data from ED patients at high risk of opioid overdose enrolled in a randomized controlled trial in Rhode Island (2018–2021). We assessed baseline recovery capital using the Brief Assessment of Recovery Capital (BARC-10), dichotomized as a total score <47 versus ≥47. Post-discharge addiction treatment engagement within 30 days and non-fatal opioid overdose and fatal overdose within 18 months were assessed using statewide administrative data. We used modified Poisson regression and Cox proportional hazards models to estimate the association between recovery capital and (1) treatment engagement and (2) overdose risk, respectively, adjusting for potential confounders. Results: Among 543 participants, 32.2% had a baseline BARC-10 total score of ≥47, 32.6% engaged in treatment within 30 days, and 25.6% had a non-fatal opioid overdose and 4.2% had a fatal overdose within 18 months. BARC-10 total score was not associated with treatment engagement within 30 days (adjusted relative risk = 0.79, 95% confidence interval [CI] = 0.60–1.05) or non-fatal opioid overdose (adjusted hazard ratio [aHR] = 0.83, 95%CI = 0.57–1.20) or fatal overdose (aHR = 0.45, 95%CI = 0.14–1.40) within 18 months. Conclusion: The majority of ED patients at high risk of opioid overdose had a BARC-10 total score of <47, suggesting low recovery capital. BARC-10 total score was not associated with post-discharge treatment engagement or overdose risk. [ABSTRACT FROM AUTHOR]

Abstract Background Regarding the psychosocial aspect of treating those with substance use, it is crucial for them to exhibit a capacity for personal transformation, fully utilize their remaining capabilities, and eradicate societal discrimination. We aimed to assess the efficacy of educational instruction grounded in the theory of planned behavior (TPB) in enhancing adherence to medication regimens, fostering hope, and improving marital quality among people with substance use disorders. Methods This study was conducted at the Rapid Addiction Closure Center in Fasa city, Iran, involving a sample of 140 patients undergoing addiction treatment with methadone and buprenorphine in 2021–2022. Subjects were randomly allocated to intervention and control groups. The intervention group participated in 15 weekly educational sessions, each lasting 50 to 55 min, covering topics such as quitting strategies, social support, problem solving, communication skills, and coping mechanisms. Data were collected using demographic questionnaires, TPB construct questionnaires, Miller’s Hope Survey, and the Revised Dyadic Adjustment Scale. Results The study included 140 individuals receiving treatment for addiction. No differences were seen among the two groups in education, occupation, marital status, and living conditions before the intervention. However, six months later, the intervention group showed improvements in attitude, subjective norms, perceived behavioral control, behavioral intention, medication regimen adherence, hope, and marital quality compared to controls. Conclusion The results indicate that family-based educational interventions grounded in TPB are effective in improving medication regimen adherence, hope, and marital quality among patients with substance use disorders. Significant increases in attitude, subjective norms, perceived behavioral control, and behavioral intention positively impacted medication regimen adherence in these patients.

Aims: Methadone maintenance therapy (MMT) exhibits significant variability in pharmacokinetics and clinical response, partly due to genetic variations. However, data from sub‐Saharan African populations are lacking. We examined plasma methadone variability and pharmacogenetic influences among opioid‐addicted Tanzanian patients. Methods: Patients attending MMT clinics (n = 119) in Tanzania were genotyped for common functional variants of the CYP3A4, CYP3A5, CYP2A6, CYP2B6, CYP2C19, CYP2D6, ABCB1, UGT2B7 and SLCO1B1 genotypes. Trough plasma concentrations of total methadone, S‐methadone (S‐MTD) and R‐methadone (R‐MTD), with their respective metabolites, 2‐ethylidene‐1,5‐dimethyl‐3,3‐diphenylpyrrolidine (EDDP), were quantified using liquid chromatography–tandem mass spectrometry (LC–MS/MS). The methadone‐to‐EDDP metabolic ratio (MMR) was used to categorize the phenotype. Results: The proportions of MMR‐predicted ultrarapid, extensive, intermediate and slow methadone metabolizer phenotypes were 2.5%, 58.2%, 23.7% and 15.6%, respectively. CYP2B6 genotype significantly correlated with S‐methadone (P =.006), total methadone (P =.03), and dose‐normalized methadone plasma concentrations (P =.001). Metabolic ratios of R‐methadone (R‐MTD/R‐EDDP), S‐methadone (S‐MTD/S‐EDDP), and total methadone (MMR) were significantly higher among patients homozygous for defective variants (*6 or *18) than heterozygous or CYP2B6*1/*1 genotypes (P <.001). The metabolic ratio for S‐MTD and total methadone was significantly higher among ABCB1c.3435T/T than in the C/C genotype. No significant effect of CYP2D6, CYP2C19, CYP3A4, CYP3A5, CYP2A6, UGT2B7 and SLCO1B1 genotypes on S‐methadone, R‐methadone, or total methadone was observed. Conclusions: Approximately one in six opioid‐addicted Tanzanian patients are methadone slow metabolizers, influenced by genetic factors. Both the CYP2B6 and ABCB1 genotypes are strong predictors of methadone metabolic capacity and plasma exposure. Further investigation is needed to determine their predictive value for methadone treatment outcomes and to develop genotype‐based dosing algorithms for safe and effective therapy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to attempt to verify the existence of a relationship between internal resources (self-esteem and self-efficacy) and motivation (decisional balance) to undergo treatment in prisoners with alcohol addiction participating in voluntary treatment as well as referred to obligatory addiction treatment based on a court decision. The study was carried out in penitentiary units in various parts of Poland in 2018–2019. Participants completed the Decision Balance Scale, Generalized Self–Efficacy Scale, and Multidimensional Self-Esteem Inventory twice – before and after addiction treatment. The study adopted the assumptions of the Transtheoretical Model developed by Prochaska and DiClemente (1984). There were no statistically significant differences between the group of prisoners referred for obligatory treatment and those undergoing voluntary therapy. At the end of the 3-month treatment, there was a significantly smaller number of arguments "for" drinking and less identity integration in both groups studied. The results obtained may indicate that after undergoing therapy, prisoners remain in a contemplation stage due to their inability to adapt therapeutic interactions to individual needs. It seems that changes in identity integration may be indicative of the crisis that is being experienced, which in effect may allow individuals with alcohol addiction to search for and achieve a potentially new, coherent image of themselves. • Addiction treatment, should focus on the resources of the convicted rather than their deficits. • Higher self-esteem increases the motivation to complete therapy and continue it after the end of incarceration. • Motivation plays a significant role in the completion of alcohol therapy, so it is important to diagnose patients in this regard before starting therapy, instead of mistakenly assuming the lack of motivation and the need to induce it. • People who undergo therapy with a court order only begin to realize the problem of alcohol dependence and begin to think about changing their behavior during the therapy. [ABSTRACT FROM AUTHOR]

Background: Congress 60 is an NGO that offers services to drug abusers, but its underlying theory has not been explored in previous studies. The purpose of this study is to examine the changes in the physical dimensions of the people treated in Congress 60. Methods: Grounded theory methodology was used to arrive at the underlying theory of Congress 60. The data were collected from 2021 to 2023 through interviews with 21 individuals, participant observation, and a review of available texts from Congress 60. Data were analyzed in MAXQDA 2020 following the constant comparison method recommended by Corbin and Strauss in 2014. Findings: The core concept included "Addiction-related transformations in body structures". Addiction-related transformations in body structures include addictive body structures (addiction and chronic substitution, and nervous system and external substances) and healthy body structure (opium tincture medicine, opium tincture dosage measurement, and taper-up-off of opium tincture in over time or Dezhakam Step Time). Conclusion: The theory of "Addiction-related transformations in body structures" derived from this study explains the process of entering and leaving addiction from the perspective of Congress 60. A person using drugs enters Congress 60 with addicted body structures. In Congress 60, using the right dose of opium tincture medicine and the Dezhakam Step Time (DST) method, the person's body structures return to normal. The findings of this study offer a novel perspective on addiction, suggesting potential avenues for further research through the exploration of various hypotheses. [ABSTRACT FROM AUTHOR]

ABSTRACT In addiction treatment, harm reduction is a philosophy that aims to reduce the harms from ongoing alcohol and other drug use. Although abstinence may be the ‘gold standard’ in reducing harm from ongoing alcohol and other drug use, harm reduction recognises that abstinence may not be achievable for certain individuals. Accordingly, harm reduction is used to enable medical or mental health treatment for individuals who continue to use alcohol and other drugs, providing a form of care which meets individuals where they present to healthcare facilities. Harm reduction accepts ongoing alcohol and other drug use, while providing a traditionally marginalised cohort of individuals access to healthcare services. In this perspective paper, we argue that the role of nurses in promoting and utilising harm reduction as part of their regular practice is essential to both reducing harm from alcohol and other drug use, engaging individuals who use alcohol and other drugs in healthcare services, and providing a means to accept individuals as they are to build trust and rapport for engagement in addiction treatment when they are ready, and at their own pace. Nurses, by virtue of their role and number in the healthcare landscape (approximately 28 million globally), are ideally placed to implement harm reduction in their practice to achieve better outcomes for individuals who use alcohol and other drugs. [ABSTRACT FROM AUTHOR]

Sex, relationships, and substance use often go hand in hand. Despite this, the impact of sex and relationships on recovery are often overlooked in the field of substance use disorder treatment (SUDT). This study aims to explore sex, relationships, and relapse risk for people in recovery and as an overlooked area of importance in SUDT. This qualitative study uses semi-structured interviews with people currently and/or formerly in prison, together with ethnographic field data from four high security prisons in Norway, collected between July 2021–April 2022. Common sources of anguish around sex after release and recovery included both forming new and maintaining long-term relationships with partners at a different stage in their recovery, dating and initiating sexual relationships with new partners, concerns about sexual performance and fears around attaining sexual pleasure without chemical enhancements. The implications that sex, dating and intimate relationships may have for individual relapse to substance use, can and should play a greater role in both SUD treatment and preparation for release from prison. These problems are exacerbated in carceral settings and should be considered when planning re-entry to the community and in the development of individual relapse prevention strategies. [ABSTRACT FROM AUTHOR]

This research aims at studying the cognitive distortions and psychosis among the meth-amphetamine users. This study was exploratory in nature and qualitative research design was used. The sample size of this study was N=19 meth-amphetamine users who were residing in different rehabilitation centers of Islamabad/Rawalpindi and convenient sampling technique was used. Semi-structured interviews were conducted and then the thematic analysis was used to analyze the data. The results of the analysis indicates that there is a strong association between cognitive distortions and psychotic symptoms. The results also highlighted that the most common type of cognitive distortions includes all or nothing thinking, mental filtering, and catastrophizing. This study has shown that hallucinations and paranoid delusions can cause significant harm to their day-to-day functioning as well as to their quality of life. The research highlight the critical role that social and emotional support plays in mitigating the impact of cognitive distortions on mental illness. The results of this study highlights the need of comprehensive intervention techniques which will target both the cognitive and psychosocial levels in the treatment of addiction to prevent the relapse rate. [ABSTRACT FROM AUTHOR]

In 2016, a new addiction treatment service, Allorfik, was introduced in Greenland. Allorfik has, throughout the implementation and after, used auditing of patient records with feedback to develop the quality of care in treatment. Audits and feedback are routinely done in each treatment center. This study wishes to investigate the development of the quality of treatment through the case notes from the journal audits. This study is based on case notes audits from 2019, 2020 and 2021. In the audits, the focus has been on the quality of documentation and content for ten specific areas in each patient record. Each area was scored on a Likert scale of 0–4 for both outcomes. Statistical analyses were done using Stata 17, and P-values < 0.05 were considered statistically significant. We present baseline characteristics for patients and illustrate the development of quality for both outcomes as time trends with scatter plots. The analysis was based on data from 454 patients and audits of their case notes. The mean number of weeks in treatment is 12.72, and the mean age for the people in the audited case notes is 39. Time had a positive effect on both outcomes, and so each month, documentation increased by 0.21 points (p-value = <0.001), and content increased by 0.27 points (p-value = <0.001). For documentation and content, the quality level has increased significantly with time, and the quality of case notes is at an excellent level at the final audits of all treatment centers. [ABSTRACT FROM AUTHOR]

Opioid abuse is an epidemic in the United States with the number of deaths associated with this addiction growing each year, and yet, identification of a successful treatment plan is a major limitation to addressing this epidemic. Traditional treatment programs do not always fit for all addicts; however, equine assisted psychotherapy and learning (EAPL) shows promise as an alternative treatment option for those individuals where traditional treatment options have failed. Nevertheless, due to the novelty of this treatment option, literature concerning EAPL is limited. The purpose of this scoping review was to identify articles that address the characteristics and methodologies found in EAPL programs as it relates to opioid abuse treatment. Through the use of this scoping review, literature covering four key topics were gathered: 1) addiction treatment curriculums, 2) EAPL programs, 3) physiological effect of addiction treatment for humans, and 4) physiological effect of EAPL participation on the human and horse. Research associated with physiological effect was the most lacking of the topics covered during this review of literature. Reviewed literature pointed to a variety of populations that participate in addiction treatment programs that range from inpatient to long term recovery. EAPL programs offer an assortment of activity options to combat the challenges presented by the range of populations treated. Vital signs were mentioned in the literature reviewed as the leading way to track physiological changes but were not discussed in relation to addiction-specific treatment. Physiological measures showed change in both horses and humans who participated in equine programming but did not dictate concrete cause and effect instances. The limited literature identified through this scoping review validates the need to further explore the intentional relationship between EAPL and opioid abuse treatment programming. • Review of literature found the research associated with physiological effect of addiction treatment was the most lacking of the topics covered during the scoping review. • Reviewed literature demonstrated a range of treatment programs from inpatient to long term recovery with a focused approach in contingency management. • Equine assisted psychotherapy and learning programs showed a range of populations involved in programming and an assortment of activity options. • Vital signs were documented as the leading way to track physiological changes during addiction treatment. • Physiological measures showed change in both horses and humans who participated in equine programming but did not dictate concrete cause and effect. [ABSTRACT FROM AUTHOR]

Abstract Background Withdrawal management and opioid agonist treatment (OAT) programs help to reduce some of the harms experienced by people who use substances (PWUS). There is literature on how features of drug treatment programs (e.g., policies and practices) are helpful, or not helpful, to PWUS when seeking access to, or in, treatment. There is, however, relatively little literature based on the perspectives of family members/family of choice of PWUS and community-based organization staff within the context of Atlantic Canada. This paper explored the perspectives of these two groups on what was helpful, or not, about drug treatment programs in Atlantic Canada in terms of supporting access to, and retention in, treatment. Methods One-on-one qualitative telephone interviews were conducted in 2020 with the two groups. Interviews focused on government-funded withdrawal management and OAT programs. Data were coded using a qualitative data management program (ATLAS.ti) and analyzed inductively for key themes/subthemes using grounded theory techniques. Results Fifteen family members/family of choice and 16 community-based organization staff members participated (n = 31). Participants spoke about features of drug treatment programs in various places, and noted features that were perceived as helpful (e.g., quick access), as well as not helpful (e.g., wait times, programs located far from where PWUS live). Some participants provided their perceptions of how PWUS felt when seeking or accessing treatment. A number of participants reported taking various actions to help support access to treatment, including providing transportation to programs. A few participants also provided suggestions for change to help support access and retention such as better alignment of mental health and addiction systems. Conclusions Participants highlighted several helpful and not helpful features of drug treatment programs in terms of supporting treatment access and retention. Previous studies with PWUS and in other places have reported similar features, some of which (e.g., wait times) have been reported for many years. Changes are needed to reduce barriers to access and retention including the changes recommended by study participants. It is critical that the voices of key groups, (including PWUS) are heard to ensure treatment programs in all places support access and retention.

Background: In 2020, New Mexico had the highest alcohol related death and the 11th highest drug overdose rate in the U.S. Towards the long-term goal of addressing this public health problem, we are implementing and evaluating an multi-level intervention designed to identify adults at risk of substance use disorder (SUD) and encourage linkage to and retention in treatment. The first level includes equipping the ED and medical inpatient units of a safety-net hospital with a method to screen individuals at risk of a SUD. The second level includes Seeking Safety (SS), a trauma-specific treatment for PTSD and SUD; and pharmacotherapy for SUD. Motivational Interviewing (MI) is used throughout both levels. Using the SPIRIT guidelines and checklist, this study protocol describes the multi-level intervention and the methodology we are using to assess feasibility and effectiveness. Methods: We are using a Type 1 hybrid implementation design with a non-randomized approach (ISRCTN registration # ISRCTN33100750). We aim to enroll 110 adults ( ≧ 18) who screen positive for unhealthy use of alcohol, prescription medications (used nonmedically) and/or illicit drugs. Peer support workers are responsible for screening, using MI to increase engagement in screening and treatment and delivery of SS. Pharmacotherapy is provided by addiction clinical specialists. Treatment is provided post hospital discharge via telehealth to increase access to care. Participants are identified through (1) review of electronic health records for individuals with a chief or secondary complaint or mental health condition relating to alcohol and/or other drug use, (2) referrals from clinical staff and (3) screening in the ED and medical inpatient units. Feasibility is being measured through process data. Effectiveness will be determined by changes in two primary outcomes: (i) PTSD symptom severity; and (ii) substance use. Discussion: Our study will expand on research related to the implementation of treatment strategies for patients presenting at EDs and admitted to medical inpatients units wherein there is a significant window of opportunity to link patients with follow-up behavioral and clinical services for alcohol and/or drug misuse. The challenges associated with implementation and strategies that have been helpful to address these challenges will further inform the field. [ABSTRACT FROM AUTHOR]

In the Polish legal system, each medical procedure requires patient's consent. Exemptions from the obligation to obtain such a consent are limited by the legislator to exceptional situations, i.e., when the delay caused by the procedure for obtaining consent would pose a threat to patient's life, serious injury, or serious health impairment. Undergoing addiction treatment is also voluntary. Exceptions to this principle are stipulated by a legal act. People who abuse alcohol and therefore break down family life, demoralize minors, avoid the obligation to meet the needs of their families, or systematically disturb peace or public order, may be obliged to undergo addiction treatment in an inpatient or outpatient treatment centre on condition that they are addicted to alcohol. A patient who fails to report to the medical entity designated by the court to execute the decision on the obligation to undertake addiction treatment may be brought to this entity by the police. In the context of the obligation to obtain a consent for treatment by a person against whom a court decision containing an obligation in this respect has been issued, there are discrepancies in the application of law provisions. In some medical entities, this results in the forced continuation of addiction treatment by a given patient in hospital, as discharge from the hospital depends on a court order issued in this regard, not on the consent of the patient himself/herself. In other medical entities, patients are not admitted for treatment due to the lack of such a consent, despite the court's obligation in this respect. The article confirms that a specific practice of applying the law, which downgrades the role of the patient's consent in the therapeutic process, has negative consequences for the effectiveness of the therapy. [ABSTRACT FROM AUTHOR]

Introduction: Opioid misuse has been a growing problem in the United States that has escalated into a national public health emergency. Despite substance abuse programs that offer assistance in the treatment of opioid use disorder (OUD), keeping clients engaged in recovery treatment can be very challenging. Relapse prevention is a priority concern due to the higher risk of overdose following a period of sobriety. Aims: This research compares two different approaches to treatment of OUD to assess relative treatment adherence. The purpose of this research is to establish whether a peer support-based treatment methodology, combined with increased medication-assisted treatment, provided by an outpatient facility is more effective than treatment-as-usual in improving client engagement in recovery treatment. Methods: The research analyzed data collected over a 6-month period by a facility. The retrospective review of data compared a total of 1,570 clients enrolled in a certified recovery services (CRSs) program versus individuals engaged in treatment-as-usual program. Inclusion criteria consisted of clients with at least one diagnoses of OUD who met level of care requirements. Results: Statistical t -test analysis revealed greater engagement in recovery services among those enrolled in the CRS program. Conclusions: The findings support the benefits of a peer support program as a treatment methodology for clients with OUD. This research will be of value in the design and development of future program policy and treatment guidelines. [ABSTRACT FROM AUTHOR]

This article examines 'work therapy' in the US, a sprawling but overlooked realm of work in which people are put to work—usually without pay and employment rights—in the name of 'therapy'. For whom is work constructed as 'therapy', this article asks, what is deemed therapeutic about labour, and what are its consequences? Through content analysis of organisational documents, this article finds 'work therapy' to be a mechanism for disciplining and extracting labour from already-marginalised populations. Yet not all 'work therapy' programmes are equally disciplinary and extractive, and so this article distinguishes between those of extractive exclusion and extractive inclusion. Despite such variation, however, the commonalities between these programmes overshadow their differences. For, when organisations discursively frame work as 'therapy', their goal is to put marginalised groups to work in underpaid or unpaid jobs, while justifying workers' low or non-existent wages with unfounded claims of medical treatment. [ABSTRACT FROM AUTHOR]

Background: Withdrawal management and opioid agonist treatment (OAT) programs help to reduce some of the harms experienced by people who use substances (PWUS). There is literature on how features of drug treatment programs (e.g., policies and practices) are helpful, or not helpful, to PWUS when seeking access to, or in, treatment. There is, however, relatively little literature based on the perspectives of family members/family of choice of PWUS and community-based organization staff within the context of Atlantic Canada. This paper explored the perspectives of these two groups on what was helpful, or not, about drug treatment programs in Atlantic Canada in terms of supporting access to, and retention in, treatment. Methods: One-on-one qualitative telephone interviews were conducted in 2020 with the two groups. Interviews focused on government-funded withdrawal management and OAT programs. Data were coded using a qualitative data management program (ATLAS.ti) and analyzed inductively for key themes/subthemes using grounded theory techniques. Results: Fifteen family members/family of choice and 16 community-based organization staff members participated (n = 31). Participants spoke about features of drug treatment programs in various places, and noted features that were perceived as helpful (e.g., quick access), as well as not helpful (e.g., wait times, programs located far from where PWUS live). Some participants provided their perceptions of how PWUS felt when seeking or accessing treatment. A number of participants reported taking various actions to help support access to treatment, including providing transportation to programs. A few participants also provided suggestions for change to help support access and retention such as better alignment of mental health and addiction systems. Conclusions: Participants highlighted several helpful and not helpful features of drug treatment programs in terms of supporting treatment access and retention. Previous studies with PWUS and in other places have reported similar features, some of which (e.g., wait times) have been reported for many years. Changes are needed to reduce barriers to access and retention including the changes recommended by study participants. It is critical that the voices of key groups, (including PWUS) are heard to ensure treatment programs in all places support access and retention. [ABSTRACT FROM AUTHOR]

AIMS: To identify factors asociated with early and sustained cessation of heavy drinking. DESIGN: Retrospective cohort study over 5 years. SETTING: Kaiser Permanente Northern California, United States. PARTICIPANTS: Adults reporting heavy drinking during primary care-based alcohol screening between 1 June 2013 and 31 May 2014. The sample (n = 85 434) was 40.7% female and 33.8% non-white; mean age was 50.3 years (standard deviation = 18.1). MEASUREMENTS: Following US guidelines, early and sustained cessation of heavy drinking was defined as reporting lower-risk drinking or abstinence at 1 year and to 5 years after achieving early cessation, respectively. Associations between patient characteristics and service use and cessation outcomes were examined using logistic regression with inverse probability weights addressing attrition. FINDINGS: Nearly two-thirds of participants achieved early cessation of heavy drinking. Women [odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.35, 1.44], middle-age (35-64 years: ORs = 1.16-1.19), non-white race/ethnicity (ORs = 1.03-1.57), medical conditions (OR = 1.05, 95% CI = 1.04, 1.06), psychiatric (OR = 1.10, 95% CI = 1.06, 1.15) and drug use disorders (OR = 1.35, 95% CI = 1.17, 1.56) and addiction treatment (OR = 1.19, 95% CI = 1.09, 1.30) were associated with higher odds of early cessation, while older age (≥ 65 years: OR = 0.91, 95% CI = 0.86, 0.96), smoking (OR = 0.81, 95% CI = 0.77, 0.84), higher index drinking levels (exceeding both daily and weekly limits: OR = 0.30, 95% CI = 0.29, 0.32) and psychiatric treatment (OR = 0.91, 95% CI = 0.84, 0.99) were associated with lower odds. Among those who achieved early cessation (n = 19 200), 60.0% sustained cessation. Associations between patient factors and sustained cessation paralleled those observed in analyses of early cessation. Additionally, routine primary care (OR = 1.57, 95% CI = 1.44, 1.71) and addiction treatment post-1 year (OR = 1.41, 95% CI = 1.19, 1.66) were associated with higher odds of sustained cessation. Lower-risk drinking versus abstinence at 1 year was associated with lower odds of sustained cessation (OR = 0.62, 95% CI = 0.57, 0.66). CONCLUSIONS: Nearly two-thirds of a large, diverse sample of patients who reported heavy drinking in a Californian health-care system achieved early and sustained cessation of heavy drinking. Vulnerable subgroups (i.e. non-white patients and those with psychiatric disorders), patients who received routine primary care and those who received addiction treatment were more likely to sustain cessation of heavy drinking than other participants.

Scientific findings and policy guidelines recommend integrating HIV and drug addiction prevention and care into community-based settings. Systematic capacity-building efforts are warranted to provide technical support for community health workers and improve their confidence in the integrated service provision. An intervention trial was conducted between 2018 and 2019 with 120 community health workers (CHW) from 60 communes in Vietnam's four provinces. The 60 intervention CHW received in-person training to enhance their HIV/addiction-related service knowledge and skills. Online support groups were established between trained CHW and local HIV and addiction specialists. The intervention outcomes were assessed using mixed-effects regression models with the data collected at baseline and every 3 months for 1 year. Adjusted analyses showed that intervention CHW reported a significant increase in the interaction with other treatment providers than the control group at 6 months and remained at the 12-month follow-up. The difference in the improvement of confidence in HIV/addiction-related service delivery between the intervention and control groups was significant at 6-month but became insignificant at the 12-month. Male CHW were more confident in providing services than female CHW at baseline, and gender differences in the changing patterns were observed over time. This capacity-building intervention demonstrated promising outcomes on CHW inter-agency collaborations and confidence in service delivery. Gender divides in healthcare professionals should be attended to in future studies.

BackgroundIn 2020, New Mexico had the highest alcohol related death and the 11th highest drug overdose rate in the U.S. Towards the long-term goal of addressing this public health problem, we are implementing and evaluating an multi-level intervention designed to identify adults at risk of substance use disorder (SUD) and encourage linkage to and retention in treatment. The first level includes equipping the ED and medical inpatient units of a safety-net hospital with a method to screen individuals at risk of a SUD. The second level includes Seeking Safety (SS), a trauma-specific treatment for PTSD and SUD; and pharmacotherapy for SUD. Motivational Interviewing (MI) is used throughout both levels. Using the SPIRIT guidelines and checklist, this study protocol describes the multi-level intervention and the methodology we are using to assess feasibility and effectiveness.MethodsWe are using a Type 1 hybrid implementation design with a non-randomized approach (ISRCTN registration # ISRCTN33100750). We aim to enroll 110 adults (≧18) who screen positive for unhealthy use of alcohol, prescription medications (used nonmedically) and/or illicit drugs. Peer support workers are responsible for screening, using MI to increase engagement in screening and treatment and delivery of SS. Pharmacotherapy is provided by addiction clinical specialists. Treatment is provided post hospital discharge via telehealth to increase access to care. Participants are identified through (1) review of electronic health records for individuals with a chief or secondary complaint or mental health condition relating to alcohol and/or other drug use, (2) referrals from clinical staff and (3) screening in the ED and medical inpatient units. Feasibility is being measured through process data. Effectiveness will be determined by changes in two primary outcomes: (i) PTSD symptom severity; and (ii) substance use.DiscussionOur study will expand on research related to the implementation of treatment strategies for patients presenting at EDs and admitted to medical inpatients units wherein there is a significant window of opportunity to link patients with follow-up behavioral and clinical services for alcohol and/or drug misuse. The challenges associated with implementation and strategies that have been helpful to address these challenges will further inform the field.

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Copyright of Polish Nursing / Pielegniarstwo Polskie is the property of Poznan University of Medical Sciences Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Veterans receiving substance use disorder (SUD) treatment are at a clear elevated risk for engaging in suicidal behaviors. Intervening to reduce suicide risk during an episode of SUD treatment could meaningfully target a key high-risk group of Veterans. Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) was developed to reduce the frequency and duration of suicidal ideation, as well as decrease suicidal behaviors. The form of CBT-SP in this study progressed from building an understanding of the cognitive model to practicing new skills, and highlighted the links between substance use, craving, self-efficacy and suicidal ideation and attempts. CBT-SP was compared to an attention matched 8-session control condition (termed Supportive Psychoeducational Control [SPC]) during a multi-site randomized controlled trial for 299 Veterans receiving outpatient SUD treatment services within the Veterans Health Administration. The frequency of suicidal ideation remained relatively constant over 24-months of follow-up, however the duration of suicidal ideation decreased, and suicide attempts decreased relative to baseline in both conditions. Forty-two participants (14%) reported at least one suicide attempt during the 2-year follow-up period. No statistically significant differences were found between CBT-SP and SPC on any of these outcomes. Analyses of secondary outcomes indicate that preparatory behaviors for suicide were less common among those in the CBT-SP condition than SPC across the 24-month follow-up (OR, 95%CI = 0.44 (0.25, 0.79); p = 0.02). Veterans in SUD treatment are a high-risk group and delivery of suicide-specific interventions is feasible during SUD care. However, results did not indicate that CBT-SP was superior to SPC on any primary outcomes, underscoring the importance of identifying and testing alternative approaches that support suicide reduction in this group. [ABSTRACT FROM AUTHOR]

This study examined nicotine and cannabis vaping among adolescents in treatment for substance use disorders. Participants were 363 adolescents aged 12-17 (66% male, mean age = 15.5 [SD = 1.3], 46% non-Hispanic white) seen for a specialty addiction intake evaluation between 2017 and 2019 at one of six medical offices of a large, integrated health care system in Northern California. Multivariable logistic regression models tested for associations of sociodemographics, cigarette smoking, and substance use disorders with vaping behaviors. A majority of adolescents reported ever (68%) or current vaping (60%) of nicotine and/or cannabis; current vaping was similar for nicotine (50%) and cannabis (51%); 40% reported current vaping of both. Current smokers (6% of the sample) had higher odds of ever vaping (aOR = 3.95, 95%CI: 1.04-14.95). Black (versus non-Hispanic white) adolescents had lower odds of current nicotine vaping (aOR = 0.08, 95%CI: 0.02-0.37) and current vaping of both nicotine and cannabis (aOR = 0.12, 95%CI: 0.03-0.60). Having an alcohol use disorder was associated with current vaping (aOR = 2.14, 95%CI: 1.06-4.33). Those who endorsed that most friends get drunk/high (aOR = 1.87, 95%CI: 1.02-3.42) or that cannabis was their substance of choice (aOR = 2.36, 95%CI: 1.16-4.81) had higher odds of current cannabis vaping. Higher neighborhood household income ($80,000-$120,000 and >$120,000 vs.

The article comments on a study which investigated the use of peer support services in the treatment of substance use disorder (SUD) including opioid use disorder. It considers peer recovery support specialists (PRSS) as a recovery-oriented model of care and a more active support than traditional approaches. It agrees with supporting the work of PRSS in the emergency room and suggests the need to examine elements of emergency room-based peer support programs for opioid overdose survivors.

This letter responds to Cernat et al.'s study on counseling about cannabis use during pregnancy and lactation, drawing parallels with addiction treatment practices in Taiwan. We highlight the importance of open, non‐judgmental approaches and harm reduction strategies in counseling pregnant women with substance use disorders. Our experience at a psychiatric center in Taiwan emphasizes the need for continuous counseling throughout pregnancy and postpartum, particularly given the observed increase in cannabis use among new mothers. We support the study's emphasis on exploring patients' perceived benefits from cannabis use and addressing underlying reasons for use. By integrating insights from qualitative studies on patient perspectives, we have improved patient engagement and outcomes in our practice. This commentary underscores the global relevance of the study's findings and calls for continued research to bridge the gap between clinician and patient experiences in perinatal cannabis use counseling. [ABSTRACT FROM AUTHOR]

Opioid use disorder (OUD) is an epidemic that costs the U.S. healthcare systems $504 billion annually and poses grave mortality risks. Existing studies investigated OUD treatment barriers via surveys as a means to mitigate this opioid crisis. However, the response rate of these surveys is low due to social stigma around opioids. We explore user-generated content in social media as a new data source to study OUD. We design a novel IT system, SImilarity Network-based DEep Learning (SINDEL), to discover OUD treatment barriers from patient narratives and address the challenge of morphs. SINDEL significantly outperforms state-of-the-art NLP models, reaching an F1 score of 76.79 percent. Thirteen types of treatment barriers were identified and verified by domain experts. This work contributes to information systems with a novel deep-learning-based approach for text analytics and generalized design principles for social media analytics methods. We also unveil the hurdles patients endure during the opioid epidemic. [ABSTRACT FROM AUTHOR]

Introduction. Disulfiram is one of three medications approved by the Federal Drug Administration (FDA) to treat alcohol dependence. Patients tend to abstain from alcohol to avoid the unpleasant effects of alcohol toxicity. There may be some side effects, the most common of which are drowsiness, unusual tiredness, headache, metallic taste in mouth, skin rashes, decreased libido. Disulfiram induced psychosis is a psychiatric side effect that occurs very rarely. Case report. We report the case of a 33-year-old patient with nearly 15 years history of psychiatric personality disorder and alcohol dependence. Approximately 4 days of alcohol abstinence, as an inpatient he was administered disulfiram. After two weeks, the patient began to feel some side effects. He was admitted to hospital and was diagnosed with disulfiram induced psychosis. Discussion. The effect of disulfiram on alcohol metabolism was noticed in the 1940s. It should be used only by motivated patients who must be fully informed about the alcohol-disulfiram reaction. Disulfiram should only be started after about 10 days of sobriety, and the recommended dosage is 500 mg/day. The drug should be used with caution in people with a history of heart disease, diabetes mellitus, hypothyroidism, cerebral damage, nephritis, liver cirrhosis, epilepsy. Caution is recommended for patients who use benzodiazepines, some antibiotics, anticoagulants, tricyclic antidepressants. There may be some adverse effects, more serious ones include changes in vision, numbness, pain or weakness in the limbs, liver cell damage, peripheral neuropathy, seizures – but these are considered to be very rare. Psychiatric side effects may include mood changes, psychotic reactions, memory impairment. Reliable data is lacking, but cases of disulfiram induced psychosis are considered to be rare. Patients taking disulfiram should be monitored carefully.

PurposeThis paper seeks to explore and understand what constitutes successful opioid agonist therapy (OAT) programs from the views of Ukrainian OAT providers in their context-specific accounts. Prior to the ongoing war the Ukrainian addiction treatment system made great strides to expand its OAT program and increase the number of patients. Since the beginning of the war there has been much alarm that those hard-earned successes will be destroyed. However, emerging evidence suggests that the Ukrainian OAT programs have shown signs of resilience in the face of adversity albeit at great cost. What aspects of the OAT programs developed prior to the crisis have been helpful to allow them to weather the storm? Using the data from 24 addiction treatment providers, this paper describes the essential elements of the OAT programs that preceded the current crisis which made them robust over time. By examining the narratives of the participants interviewed pre-war and pre-COVID-19 the paper reveals structural and cultural elements of the OAT programs before the perfect storm that are likely to endure. To the best of our knowledge, no one else has investigated OAT providers perspectives in Ukraine prior to the crisis which makes this paper extremely salient to understand both the robustness and the vulnerability of MAT programs in Ukraine during the war and going forward.MethodologyThe data come from qualitative semi-structured interviews with 24 OAT providers throughout 5 regions of Ukraine. Participants included front-line clinicians, head narcologists, and chief doctors from TB clinics, district hospitals and drug addiction centers. Using a coding scheme of 103 inductively developed categories we explored participants’ perceptions of their OAT program.FindingsIn the stories shared by clinicians pre crisis, three major interconnected themes focused on economic uncertainty at the institutional level (leading to under-staffing), structural capacity of the program, and clinicians’ professional identity, shaping differing views on application of rules for administrative discharge, take-home dosing, and the potential for scale-up. Knowing the data collection was completely unbiased to the current crisis, interpreting the findings helps us understand that OAT clinicians have had “years” of training under conditions of duress in Ukraine to overcome barriers, find creative solutions and form a support network that became indispensable in surviving the current humanitarian catastrophe.ConclusionIn the discussion we point out that the current crisis magnified the pre-existing challenges as the providers approach toward overcoming them was already largely present before the crisis (just on a different scale). The underlying fragility of resources was a constant since OAT inception in Ukraine. Historically, providers in Ukraine operated in a system that was under-funded in the absence of solid governmental funding for OAT programs, yet they came up with solutions which required ingenuity that they took pride in. This gives hope that addiction treatment in Ukraine and OAT programs will not be casualties of this humanitarian crisis and providers and their patients will persevere.

Copyright of Medicina Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Zero Suicide (ZS) model is a promising approach for preventing all suicides across health care settings. ZS provides guidelines for health care systems to implement best practices in suicide prevention. Patients with substance use disorders are at increased risk for suicide, but no known research has investigated how to integrate the ZS model into addiction treatment settings. This Open Forum encourages clinicians and researchers to integrate ZS into such settings and to study its feasibility and effectiveness. ZS integration into addiction treatment may improve both suicide and addiction outcomes, but additional research is needed. [ABSTRACT FROM AUTHOR]

Drawing on ethnography and interviews with recovering men in the Twin Cities, Minnesota, this study explores how two dominant models of American rehab are racialized — coerced treatment theorizing addiction as criminal personality—and a more medicalized, voluntaristic model rooted in the brain disease paradigm. At the "carceral rehab" of "Arcadia House," staff assumed its majority court-mandated, poor men of color would arrive resistant to reforming their "lifestyle addictions," justifying treatment backed by (re)incarceration. In contrast, "Healing Bridges" offered its gentler, "medical-restorative rehab" to mostly white, middle-class patients who escaped incarceration despite substantial participation in drug-related crime. While both programs mobilized the colorblind logic that "addiction doesn't discriminate," local disparities routed recovering men into vastly different treatments, disproportionately criminalizing the addictions of the Black poor. In a racialized binary operating across the field, Arcadia's clients of color were viewed as sicker and more out of control than Bridges' white patients. While Arcadia's clients required coercive state management, Bridges' patients were understood as already possessing the capacity for self -management—reinforcing staff's mission to empower the non-addict within. Distinctions between coerced and voluntary treatment were naturalized and mapped onto recovering men, reproducing race at the most intimate levels of self-making. [ABSTRACT FROM AUTHOR]

INTRODUCTION: More than four decades of war and tragedy have destroyed most of the public infrastructure in Afghanistan. Currently, drug use is a major public health crisis in the country and drug treatment services have extremely limited coverage. This article is a review of substance use problem and treatment situation prior to the reinstatement of Taliban. The aim of this article is to provide evidence-based recommendations for policy makers to improve substance use treatment services and to integrate some components of this sector into primary health care and to ensure sustainability of services. METHODS: A systematic search was conducted using key databases Medline, Embase, PsycINFO and Global Health. Manual search was also conducted to find further studies using Google Scholar, WHO, UNODC, relevant NGOs and Afghan government websites. RESULTS: Substance use treatment programs have significant achievements over the last recent years in Afghanistan. However, many challenges need to be addressed. Current treatment programs are mainly donor dependent, and their sustainability is not ensured. CONCLUSIONS: Substance use treatment sector has made significant progress in Afghanistan. But almost all programs have been in forms of shortterm projects funded by external donors. Communitybased approaches and expanding care to rural areas need to be prioritized as reasonable and cost-effective alternatives for the current resource-intensive programs. Further coordination mechanisms need to be established among different stakeholders to mobilize resources and engage community and local actors. [ABSTRACT FROM AUTHOR]

Background: The war in Ukraine has posed significant challenges to the healthcare system. This paper draws upon expert consultations, held between December 2022 and February 2023, focused on HIV/AIDS, addiction, and mental health service delivery during the first year of this war, and following the Global Mental Health Humanitarian Coalition panel discussion in May 2022. Objectives: This commentary presents the experiences of frontline healthcare workers in Ukraine, challenges, and local adaptations to meet the increased mental health needs of healthcare providers. We aimed to document the adaptations made in the addiction healthcare system and to acknowledge the changes in vulnerabilities and lessons learned. Results: Burnout among healthcare providers delivering addiction, HIV/AIDS and mental health services became more visible after the second half of 2022. Challenges included increased workload, contextual threats, lack of job relocation strategies, and money-follow-the-patient policies. Recommendations: The lessons from the first year of war in Ukraine hold significant generalizability to other contexts. These include enabling bottom-up approaches to tailoring services and allowing healthcare providers to respond to the dynamics of war in an effective and active manner. Other recommendations include departmental-specific resources and strategies, particularly as vulnerable groups and challenges are unstable in humanitarian contexts. Conclusions: Globally and in Ukraine, healthcare workers need more than applause. Along with monetary incentives, other strategies to prevent burnout, ensure sustainable capacity building, job relocation opportunities, and bespoke adaptations are imperative to protect healthcare providers' wellbeing and overall public health. [ABSTRACT FROM AUTHOR]

This study explored the training needs of substance use disorder (SUD) treatment practitioners in relation to their readiness in treating queer clients. We conducted a series of semi-structured interviews (N = 7) based in the Western Cape of South Africa. A thematic analysis identified themes related to treatment structures developed for a binary perception of gender, the burden of discrimination borne by queer clients that may impede treatment, and practitioner interest in further training and development. Our findings suggest that SUD treatment practitioners do not feel fully prepared to treat queer clients and are aware of a need for gender-sensitive training in this area. Improvements to practitioner training and readiness could yield benefits for both clients and practitioners within the treatment space. [ABSTRACT FROM AUTHOR]

Background: In the US, seventy percent of drug-related deaths are attributed to opioids. In response to the ongoing opioid crisis, New Jersey's (NJ) Medicaid program implemented the MATrx model to increase treatment access for Medicaid participants with opioid use disorder (OUD). The model's goals include increasing the number of office-based treatment providers, enhancing Medicaid reimbursement for certain treatment services, and elimination of prior authorizations for OUD medications. Objectives: To explore office-based addiction treatment providers' experiences delivering care in the context of statewide policy changes and their perspectives on treatment access changes and remaining barriers. Methods: This qualitative study used purposive sampling to recruit office-based New Jersey medications for opioid use disorder (MOUD) providers. Twenty-two providers (11 females, 11 males) discussed treatment experiences since the policy changes in 2019, including evaluations of the current state of OUD care in New Jersey and perceived outcomes of the MATrx model policy changes. Results: Providers reported the MOUD climate in NJ improved as Medicaid implemented policies intended to reduce barriers to care and increase treatment access. Elimination of prior authorizations was noted as important, as it reduced provider burden and allowed greater focus on care delivery. However, barriers remained, including stigma, pharmacy supply issues, and difficulty obtaining injectable or non-generic medication formulations. Conclusion: NJ policies may have improved access to care for Medicaid beneficiaries by reducing barriers to care and supporting providers in prescribing MOUD. Yet, stigma and lack of psychosocial supports still need to be addressed to further improve access and care quality. [ABSTRACT FROM AUTHOR]

Copyright of Recht & Psychiatrie is the property of Psychiatrie Verlag GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Addiction treatment is one of the challenges facing mental health studies, leading to failure if psychological components are not considered. Aim: The present study aimed to compare the effectiveness of emotion-focused therapy and schema therapy on the self-efficacy of addicts undergoing methadone maintenance treatment. Method: The research was a quasi-experimental study with a pretest-posttest control group design. The study population included all addicts undergoing methadone maintenance treatment in de-addiction clinics in district 5 of Tehran during 2021-2022, of which 3 clinics and 54 patients were purposefully selected, based on the inclusion and exclusion criteria and placed randomly in two experimental groups and one control group. The research instrument was Sherer's General Self-efficacy Scale (1982). The data were analyzed using repeated measures ANOVA and Bonferroni post hoc test through SPSS-26. Results: The results showed that schema therapy significantly affected self-efficacy (P

Background and Aims: The Opioid Use Disorder (OUD) Cascade of Care is a public health model that has been used to measure population‐level OUD risk, treatment engagement, retention, service and outcome indicators. However, no studies have examined its relevance for American Indian and Alaska Native (AI/AN) communities. Thus, we aimed to understand (1) the utility of existing stages and (2) the relative 'fit' of the OUD Cascade of Care from a tribal perspective. Design, Setting, Participants and Measurements: Qualitative analysis of in‐depth interviews with 20 individuals who were knowledgeable regarding the treatment of OUD in an Anishinaabe tribal setting in Minnesota, USA. Community member roles included clinicians, peer support specialists and cultural practitioners, among others. Thematic analysis was used to analyze the data. Findings: Participants identified the key transition points of prevention, assessment, inpatient/outpatient pathways and recovery as relevant to their community. They re‐imagined an Aanji'bide (Changing our Paths) model of opioid recovery and change that was non‐linear; included developmental stage and individual pathways; and demonstrated resilience through connection to culture/spirituality, community and others. Conclusions: Community members living/working in a rural tribal nation in Minnesota, USA identified non‐linearity and cultural connection as key elements to include in an Anishinaabe‐centered model of opioid recovery and change. [ABSTRACT FROM AUTHOR]