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Background: Substance use treatment (SUT) and harm reduction are often perceived as having distinct goals despite people who use drugs routinely having needs that encompass both services. The co-occurring SUT and harm reduction needs of people who use drugs warrant collaboration between service providers. However, little work has explored such collaborations, or lack thereof. This research explores how SUT providers responded to expanded harm reduction programming from the perspectives of syringe services program (SSP) operators in Michigan. Methods: We conducted in-depth, semi-structured interviews with a geographically diverse sample of SSP operators (n = 19) in Michigan during October and November 2021. The interview guide broadly explored the contributing factors to SSP implementation, including SSP relationships with SUT providers. Analyses of transcribed interviews were conducted using an iterative, thematic constant comparison process informed by grounded theory. Results: Participants described a range of responses to SSP implementation from SUT providers. Many SSP operators identified significant barriers to effective collaboration with SUT providers due to lack of awareness about harm reduction approaches and stigmatization of drug use. For example, SUT providers were often reluctant to accept free harm reduction supplies (e.g., sterile syringes, naloxone) to offer their clients. Participants also reported difficulties connecting their clients to evidence-based SUT providers. Incremental relationship building and education about the role of harm reduction in recovery were required for effective collaboration between SUT providers and SSPs. Conclusions: Tensions between SUT and harm reduction providers may create challenges that impede recovery among people who use drugs. Ensuring SUT and harm reduction providers understand the unique and complementary roles of each approach is necessary to advance the health of people who use drugs. [ABSTRACT FROM AUTHOR]

Purpose: Recreational nitrous oxide (N2O) misuse is increasing globally. Chronic misuse can cause neurological impairments that require rehabilitation, though literature characterising rehabilitation is limited. This study aimed to evaluate rehabilitation service provision for impairments resulting from N2O misuse. Methods: A retrospective audit of hospitalised patients referred for rehabilitation for N2O toxicity was conducted between 2015 and 2022 at a single metropolitan hospital. Data were collected via medical record audit and analysed via descriptive and non-parametric statistics. Results: 16 eligible cases were identified, aged 18–43 years (50% female/male), with increasing case frequency. 12 cases received inpatient rehabilitation episodes for multifactorial sensorimotor, cognitive and psychosocial impairments. Cases articulated diverse rehabilitation goals and received intervention from a median of 6 clinical disciplines. All cases required assistance to mobilise or perform self-care activities on admission. Functional Independence Measure (FIM) scores significantly improved with rehabilitation (median FIM 84[75–93] to 117[112–123], p <.001). Despite gains in independence, all cases required referral for ongoing rehabilitation post-discharge. Conclusions: Demand for inpatient rehabilitation for disabling N2O toxicity appears to be increasing. In this series, cases were young, exhibited serious impairments, and had multidisciplinary rehabilitation needs. Inpatient rehabilitation led to significant functional improvements, though ongoing disability was evident post-discharge. IMPLICATIONS FOR REHABILITATION: There appears to be rising demand for multidisciplinary rehabilitation to manage neurological disabilities from recreational Nitrous Oxide (N2O) misuse. Heavy N2O misuse can cause serious impairments and activity limitations across sensorimotor, cognitive and psychosocial domains. Intensive, multidisciplinary rehabilitation can improve functional independence for people with disabling N2O toxicity; specialist rehabilitation services should be involved in optimising care of this population. Ongoing disability and the need for longer-term rehabilitation and support following hospital discharge were evident in severe cases of N2O toxicity. [ABSTRACT FROM AUTHOR]

Background and Objectives: Assessment and care of substance use disorder within mental health services are essential due to the high prevalence and harms associated with comorbidity. Substance use disorder assessment and care are routinely recommended in clinical guidelines; however, processes are not agreed. This systematic review of routine clinical practice in relation to substance use disorders in adult mental health service aims to identify routine assessment and diagnosis processes, the proportion of patients and service episodes in which they occur and their outputs. Methods: We searched MEDLINE, PsycINFO, Embase and relevant Cochrane databases for articles until July 2024 reporting on substance use assessment, diagnosis or treatment in adults receiving routine mental health service and locating additional articles by snowballing. Variables including setting, study method, period, cohort, substances, clinical assessment type, diagnosis and care pathways were compared. Results: In 137 heterogeneous studies reporting routine practice within a wide variety of adult mental health service from 29 nations, 44 (32%) expected or reported on substance use assessment in domains of pattern or impact. However, 23 studies (17%) reported structured approaches to substance use disorder assessment, while 67 (49%) reported a diagnostic structure, including classification system. Diagnostic prevalence varied markedly. Treatment was reported in 16 studies (12%) and no substance use disorder outcomes were reported. Conclusion: This systematic review shows marked variation in routine practice in mental health service across a range of substance use disorder assessment and diagnosis processes. To better identify substance use disorder, enhance its care and reduce associated morbidity, adult mental health service may benefit from standardising expectations and systematically monitoring the performance of substance use assessment and diagnosis. [ABSTRACT FROM AUTHOR]

This study investigated multivariate relations between indicators of lifetime adversity and past year risky substance use reported by an Internet-recruited sample of transgender emerging adults from the United States (N = 248, age M = 22.61 years). Canonical correlation analysis (CCA) documented the canonical correlation between canonical variates in this sample (.362), as well as the amount of shared variance (13.1%) between set of variables representing lifetime adversity and past year risky substance use. Examination of the standardized canonical coefficients and structure coefficients highlighted the important contributions of (a) past year drug use and negative consequences of substance use to the synthetic criterion variable and (b) lifetime intimate partner violence to the synthetic predictor variable. Information generated in this study about how specific observed variables contributed to canonical variates may be used to tailor trauma-informed selected interventions in clinical socialwork practice with transgender emerging adults who report substance use problems. [ABSTRACT FROM AUTHOR]

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]

Background: Drug-related deaths, including accidental and intentional overdose and other drug-related causes, are among the leading causes of maternal mortality in the United States. Analysis: Addiction care providers can contribute to efforts to decrease maternal mortality related to substance use disorder. In this report, we review current research to inform the care of pregnant and parenting people with substance use disorder (SUD) to address rising drug-related deaths. Conclusions and Relevance: A multidisciplinary approach to the care of pregnant people with SUD should include prioritizing SUD and mental health treatment, helping them access services such as housing, transportation, and nutrition programs, and providing extended care for at least the year after end of a pregnancy. Efforts to improve care for childbearing people promote health and well-being for everyone. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic highlighted gaps in meeting adolescent behavioral health needs, primary care providers (PCPs) were a locus for interventions to address adolescent mental health and substance use concerns. Strength-based approaches may support PCP promotion of positive behavioral health in adolescents, but competing priorities or other factors may inhibit their use. We analyzed health record review data from 31 primary care practices to assess utilization of strength-based approaches during the health supervision visit (HSV) for adolescents with and without behavioral health concerns. We found that most had strengths identified (78%) or well-being topics addressed (83%). However, adolescents screening positive for depression were 40% less likely to have strengths identified, whereas those screening positive for anxiety or substance use were 89% and 163%, respectively, more likely to have well-being topics addressed. Primary care providers may need support for integrating strength-based approaches when managing adolescents screening positive for depression. [ABSTRACT FROM AUTHOR]

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Introduction: Major depression and alcohol use disorder affect millions of individuals worldwide and cause significant disability. They often occur together, and their co-occurrence is associated with more negative outcomes than each disorder on its own. Yet, there is a lack of knowledge on how to best treat co-occurring depression and alcohol use disorder. A pilot study was conducted to investigate the feasibility, credibility, patient satisfaction, preliminary effect, and potential negative effects of an integrated treatment for depression and alcohol use disorder, which has shown promising results in an earlier pilot trial. Methods: The study was conducted at an outpatient unit in Stockholm, Sweden. Women (n=7) with current depression and alcohol use disorder were offered integrated group treatment that included evidence-based treatment for depression and alcohol use disorder. Criteria for feasibility were based on an earlier study, treatment credibility was measured using the Credibility/Expectancy Questionnaire and patient satisfaction with the Client Satisfaction Questionnaire. Results: Feasibility, credibility, and patient satisfaction were high. Depression symptom severity and alcohol consumption decreased from baseline to follow up. Negative effects were reported in terms of increased adverse emotional experiences. Discussion: The investigated integrated treatment for co-occurring depression and alcohol use disorder continues to show promise. Randomized clinical trials are needed to evaluate its effectiveness. [ABSTRACT FROM AUTHOR]

Background: High unmet need for treatment of mental disorders exists throughout the world. An understanding of barriers to treatment is needed to develop effective programs to address this problem. Methods: Data on barriers were obtained from face-to-face interviews in 22 community surveys across 19 countries (n = 102,812 respondents aged ≥ 18 years, 57.7% female, median age [interquartile range]: 43 [31–57] years; 68.5% weighted average response rate) in the World Mental Health (WMH) surveys. We focus on the n = 5,136 respondents with 12-month DSM-IV anxiety, mood, or substance use disorders with perceived need for treatment. The n = 2,444 such respondents who did not receive treatment were asked about barriers to receiving treatment, whereas the n = 926 respondents who received treatment with a delay were asked about barriers leading to delays. Consistent with previous research, we distinguished five broad classes of barriers: low perceived disorder severity, two types of barriers in the domain of predisposing factors (beliefs/attitudes about treatment ineffectiveness and stigma) and two types in the domain of enabling factors (financial and nonfinancial). Baseline predictors of receiving treatment found in a prior report (i.e., comparing the n = 2,692 respondents who received treatment with the n = 2,444 who did not) were examined as predictors of barriers, while barriers were examined as mediators of associations between these predictors and treatment. Results: Most respondents reported multiple barriers. Barriers among respondents who did not receive treatment included low perceived severity (52.9%), perceived treatment ineffectiveness (44.8%), nonfinancial (40.2%) and financial (32.9%) barriers in the domain of enabling factors, and stigma (20.6%). Barriers causing delays in treatment had a similar rank-order but were reported by higher proportions of respondents (X21 = 3.8–199.8, p = 0.050− < 0.001). Barriers were predicted by low education, disorder type, age, employment status, and financial obstacles. Predictors varied as a function of barrier type. Conclusions: A wide range of barriers to treatment exist among people with mental disorders even after a need for treatment is acknowledged. Most such individuals have multiple barriers. These results have important implications for the design of programs to decrease unmet need for treatment of mental disorders. [ABSTRACT FROM AUTHOR]

Background: Drug rehabilitation is a challenging process that impacts both the physical and mental health of individuals. Traditional martial arts, such as Health Qigong, and closed motor exercises, such as power cycling, have shown potential benefits in improving health outcomes. This study aims to compare the effects of Health Qigong, closed motor exercises, and their combination on the physical and mental health of female drug rehabilitation participants. Methods: In this randomized controlled trial, female participants from the Jilin Province Women's Compulsory Isolation Drug Rehabilitation Center were randomly assigned to three groups: Health Qigong (QigongG), Closed Motor Exercise (ClosedG), and Combined Health Qigong and Closed Motor Exercise (CombinedG). Measurements were taken at baseline, mid-intervention, and post-intervention and included resting heart rate, vital capacity, choice reaction time, sleep quality, and relapse tendency. Results: At the study's conclusion, the ClosedG group showed significant improvements in relapse tendency, vital capacity, and sleep quality compared to baseline. The QigongG showed significant improvements in relapse tendency, sleep quality, and choice reaction compared to baseline. The CombinedG group demonstrated significant improvements in relapse tendency, vital capacity, sleep quality, and choice reaction time, outperforming the ClosedG groups in reaction time, and outperforming QigongG groups in vital capacity. The CombinedG group exhibited the most notable overall improvements. Conclusion: The combined intervention of Health Qigong and closed motor exercises is more effective in improving physical and mental health metrics among female drug rehabilitation participants than either intervention alone. These findings suggest that incorporating a combination of traditional martial arts and closed motor exercises could enhance rehabilitation programs for drug rehabilitation. Trial registration: ClinicalTrials.gov NCT06454565. The date of registration is 2024.07.11 (Retrospectively registered). [ABSTRACT FROM AUTHOR]

Background: Despite the paramount importance of oral health, individuals undergoing treatment for opioid use disorder face unique challenges beyond traditional addiction care. This qualitative study explores the challenges Opioid Treatment Program (OTP) clients in Australia encounter when accessing oral health care, aiming to understand the underlying factors and identify effective strategies for integrating oral health into an OTP. Methods: Semi-structured interviews were conducted with OTP clients, OTP clinicians and oral health clinicians using tested interview guides. Thematic analysis identified patterns and themes across participants' responses. Results: Client behaviour and traits such as inadequate health prioritisation, crisis-driven care and lack of motivation, shaped by a complex social environment, contribute significantly to inconsistent care and neglected oral health. Addiction exacerbates oral health issues as clients prioritise drug use over oral care and financial constraints, resulting in poor oral hygiene and a higher prevalence of dental problems. Psychological barriers such as dental anxiety deter clients from seeking care, while access issues including administrative burdens and system barriers, lost phones and unstable living conditions hinder consistent management of oral health. Stakeholders recommend actionable steps to address OTP clients' challenges, including integrating holistic care, establishing collaborative support systems, improving awareness and education and enhancing accessibility and flexible scheduling. Conclusion: This study established a framework for improving OTP clients' oral health through integrated, holistic strategies. By addressing gaps in existing research, it supports the development of public health policies integrating oral health care into OTPs, aiming to foster collaboration, improve access and advance client education for better health outcomes. Opioid Treatment Program (OTP) clients face significant challenges in prioritising oral health due to addiction-related issues, unstable living conditions, lack of motivation and dental anxiety. Clinicians from both OTPs and oral health services identify inadequate support systems and competing priorities as key barriers to care. To address these, proposed strategies include holistic care integration, targeted education and flexible scheduling, all aimed at improving oral healthcare access and outcomes for OTP clients. [ABSTRACT FROM AUTHOR]

This study aimed to describe the profile of women seeking treatment for the use of psychoactive substances in the city of Madrid. The study used a sample of 1968 women who sought treatment at the Addiction Care Centers (CAD) of the Madrid City Council in the year 2022, which accounted for 22.9 % of the total population attended. This quantitative study used secondary data provided by the Institute of Addictions (General Subdirectorate of Addictions, Madrid Salud). The analyses included bivariate analysis, correspondence analysis, K-means clustering, and ANOVA. Bivariate analysis was conducted to determine the association between the principal psychoactive substance and sociodemographic characteristics. Statistically significant results were employed to develop a correspondence analysis and used to conduct a K-means clustering analysis. The objective was to determine the profile of the women who sought treatment at the CAD of the Institute of Addictions (General Subdirectorate of Addictions of Madrid Salud). The results revealed three profiles of women: 1) women who use cocaine and heroin, were unemployed with children, and had lower education; 2) women who used cannabis were not working, had no children, and had intermediate education; 3) women who used alcohol had children, higher education, and were working. All three profiles were associated with situations of domestic violence, where the percentages were very high in each of the profiles, regardless of the principal substance of use and the sociodemographic and health characteristics. The results highlight the need for tailored addiction treatment approaches that address the distinct social and health profiles of women in Madrid, including challenges such as motherhood, drug-related infections, and violence. These findings emphasize the importance of providing specialized services to approach the complex needs of women undergoing addiction treatment. [ABSTRACT FROM AUTHOR]

The increasing incidence of opioid use disorder (OUD) among pregnant women in the United States constitutes a significant public health concern, jeopardizing both maternal and fetal health. Proposed solutions include opioid maintenance therapy, telemedicine, and integrated prenatal care centers. These strategies seek to mitigate harm and enhance therapeutic accessibility, yet encounter obstacles, including stigma, technological access, and ethical problems. While opioid maintenance therapy stabilizes addiction, telemedicine expands access, and integrated centers streamline care, each strategy requires policy support, community acceptance, and further evaluation to optimize outcomes for pregnant women with OUD. [ABSTRACT FROM AUTHOR]

Parents with serious mental health (MH) and substance use disorders (SUD) can face profound challenges caring for their children. MH/SUD treatment can improve outcomes for both parents and their children. This study evaluated whether parents with Medicaid with MH/SUD conditions whose children had child protective services (CPS) involvement were receiving MH/SUD treatment and whether receipt differed by race. We analyzed the 2020 Child and Caregiver Outcomes Using Linked Data (CCOULD) which contains Medicaid and child welfare records from Kentucky and Florida on 58,551 CPS-involved caregivers. Among caregivers with an MH diagnosis, White individuals were more likely than Black individuals to have received counseling (42% vs. 20%) or an MH medication (69% vs. 52%). Among caregivers with an SUD, White individuals were more likely than Black individuals to have received counseling (43% vs. 20%) or an SUD medication (43% vs. 11%). More effort is needed to connect parents with CPS involvement to MH/SUD treatment, particularly Black parents. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Opioid use disorder (OUD) is a prevalent problem among Egyptian youth, and achieving recovery and abstinence is challenging. Cognitive behavioural therapy (CBT), a well‐known approach, can be particularly beneficial when it addresses psychological aspects such as resilience and self‐esteem. What does the paper add to existing knowledge?: Our research is recognized as a trailblazer in integrating a spiritual adaptation of CBT with spiritual elements for treating patients with OUD in the Egyptian context. This innovative approach marks a significant advancement in the field.The study found a statistically significant increase in the mean scores of resilience, self‐esteem, and spirituality (p <.001 each) following the spiritual adaptation of CBT sessions compared to the control group. What are the implications for practice?: The findings can guide psychiatrists and nurses in providing more comprehensive and effective care to patients with OUD by incorporating a spiritual adaptation of CBT with spiritual components into treatment plans. Introduction: Opioid use disorder (OUD) is a prevalent problem among Egyptian youth, and achieving recovery and abstinence is challenging. Cognitive behavioural therapy (CBT), a well‐known approach, can be particularly beneficial when it addresses psychological aspects such as resilience, self‐esteem and spirituality. Aim: This study aimed to evaluate the effectiveness of a spiritual adaptation of CBT in enhancing these factors among clients with OUD. Methods: A quasi‐experimental study with a control group was conducted using a pretest‐posttest design. The study included 49 clients with OUD and 46 clients in the control group. The Rosenberg Self‐Esteem Scale–Modified Arabic Version, Daily Spiritual Experience Scale, and the Connor–Davidson Resilience Scale were used as measurement tools. CBT was delivered in 60‐min group sessions. After 3 months, the questionnaires were re‐administered to evaluate the effectiveness of a spiritual adaptation of CBT sessions. Results: The study found a statistically significant increase in the mean scores of resilience, self‐esteem and spirituality (p <.001 each) following a spiritual adaptation of CBT sessions compared to the control group. Discussion: A spiritual adaptation of CBT effectively enhanced resilience, self‐esteem and spirituality in clients with OUD. Implications for Practice: Understanding the effectiveness of a spiritual adaptation of CBT in enhancing resilience, self‐esteem and spirituality can enable psychiatrists and nurses to provide more comprehensive and effective care to patients with OUD. [ABSTRACT FROM AUTHOR]

Background: Emerging adulthood (typically ages 18–25) is a developmental period associated with increased likelihood of developing substance use disorders (SUDs) resulting in life-altering negative consequences. While SUD treatment can be effective and diminish substance-related consequences, very few emerging adults with SUDs actually receive treatment and research is needed to identify potential determinants of receiving care. We examined associations between individual factors and social determinants of health (SDOH) with SUD treatment service utilization to inform treatment engagement strategies for emerging adults. Methods: Using pooled cross-sectional data from the 2015–2019 years of the National Survey on Drug Use and Health, we evaluated past-year treatment utilization among emerging adults (i.e. respondents aged 18–25 years-old) with a past-year SUD (N = 12,594). Logistic regression analyses evaluated sex, race, education level, lifetime arrest history and age of alcohol initiation in addition to mental illness, employment, food stamp utilization, poverty status, and frequency of housing relocation. Results: Past-year mental illness, Non-Hispanic White identity, not having a college degree, lifetime arrest history, part-time employment or unemployment, and relocating for housing more than 2 times in the past year were significantly associated with greater likelihood of treatment utilization in adjusted analyses. Conclusions: Findings from this nationally representative survey of emerging adults highlight the possible contribution of some SDOH associated with social disadvantage and/or criminal justice involvement on SUD treatment utilization. These results may guide providers in tailoring service delivery mode, community organizations to target populations, and implementation strategies that are effective in reducing SUD treatment service utilization inequity. [ABSTRACT FROM AUTHOR]

Background: A qualitative exploration into the views of alcohol service staff on transdermal alcohol sensors (TAS) within three alcohol services in South London, UK. This study aims to assess the acceptability and feasibility of TAS implementation in alcohol services to provide treatment in clinical settings and identify potential challenges and solutions from the perspective of service providers. Methods: Ten participants, in a patient-facing role with alcohol-related treatment, completed a semi-structured interview. Results: Three core theoretical themes guided the analysis: perceived usefulness, perceived ease of use and attitudes toward use. Participants thought TAS could be useful as part of alcohol treatment in their service. They thought their service users may face some challenges using the TAS, (such as wearing the device; misplacing it, and/or remembering to remove and replace it for bathing). In general, participant attitudes toward TAS tended to be positive but there were some concerns about the cost and staff training. Participants believed their service users would be skeptical about wearing it, but that it could complement their treatment and motivate them toward their treatment goals. Conclusion: Results support the acceptability and feasibility of TAS within alcohol services. Participants suggested potential methods of implementing TAS within their treatment plans which could benefit both staff and users. Participants were agreeable and willing to learn more about TAS including the practicalities of implementing TAS. TAS were seen as a potentially useful treatment facilitator, if implemented correctly with sufficiently motivated service users and if specific challenges were addressed. HIGHLIGHTS: The first paper to interview clinical staff from alcohol-treatment services about transdermal alcohol sensors (TAS). Staff were positive about the implementation of TAS as a potential adjunct to alcohol treatment. Staff were skeptical about applicability and engagement with technology amongst some service users. Several practical ways to use TAS were suggested. [ABSTRACT FROM AUTHOR]

Telehealth has the potential to extend access to lifesaving treatment for opioid use disorder (OUD) among underserved people living with HIV (PWH). However, policymakers have scaled back pandemic-era telehealth provisions, citing concerns about safety and effectiveness. In this study of 42 PWH with OUD in one Deep South HIV clinic between 3/1/2020 and 4/30/2021, we used multivariable regression to assess the impact of telehealth utilization on patient-centered HIV and OUD outcomes. We found no significant difference in outcomes for those with high telehealth utilization versus others. In addition to being more accessible, telehealth does not appear to compromise health outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Rural populations in the US bear a disproportionate burden of cancer mortality, which may be partly due to their elevated tobacco use and the limited receipt of tobacco use interventions in rural healthcare settings. Here, we examine providers' use of the 5As (Ask, Advise, Assess, Assist, and Arrange), a brief tobacco cessation intervention, with their patients to assess intervention gaps. Methods: Provider practices in substance use treatment centers (SUTCs) and medical healthcare centers (MHCs), each serving rural and/or medically underserved areas (MUAs) of Texas, were compared. In total, 347 providers from 10 SUTCs (n = 174) and 9 MHCs (n = 173) responded to an anonymized survey about their cigarette and non-cigarette screening and intervention delivery, along with their perceived importance and workforce's preparedness to help patients stop using tobacco. Linear mixed and generalized linear mixed models were used to assess differences between practices at SUTCs and MHCs. Results: More MHC than SUTC providers reported that cigarette and non-cigarette tobacco use cessation intervention were (respectively) important parts of their job (p = 0.0009; p = 0.0023) and that their workforce was prepared to help their patients quit tobacco (p = 0.0275), although less than half of all respondents endorsed preparedness. Relative to those at SUTCs, MHC providers reported higher rates of asking (SUTCs = 59.57% and MHCs = 77.21%; p = 0.0182) and advising (SUTCs = 45.34% and MHCs = 72.35%; p = 0.0017) their patients to quit cigarette smoking and advising them to quit non-cigarette tobacco products (SUTCs = 43.94% and MHCs = 71.76%; p = 0.0016). Conclusions: Overall, providers in both settings may benefit from greater preparation to deliver tobacco cessation care; needs were more prevalent within SUTCs than MHCs. Our findings can inform strategic planning to improve centers' capacity to comprehensively address their patients' tobacco use in rural/MUAs of Texas, US. [ABSTRACT FROM AUTHOR]

Purposes: The present study investigated the contributory role of psychosocial capital specifically quality of life, social support and intellectual wellness as potential predictors of sustained recovery among individuals diagnosed with substance use disorders. Design/methodology: The study included 180 individuals with 95% being male and, age between 17–60 years. Participants were recruited from various addiction and rehabilitation centers located in Pakistani cities, such as Karachi, Islamabad, Lahore and Murree. To assess sustain recovery, quality of life, social support, and intellectual wellness, the Recovery Assessment Scale, Multidimensional Scale of Perceived Social Support, World Health Organization (WHO) quality of Life BREF, and Intellectual Wellness Scale respectively, were used. Findings: Results of the current study showed that quality of life, social support and intellectual wellness positively predicted sustained recovery. Furthermore, the demographic variables were also found to be significant predictors. Conclusion: The study examined the contributory role of psychosocial capital such as quality of life, social support and intellectual wellness, in predicting sustained recovery among individuals with substance use disorders. The finding revealed that these factors positively predict sustained recovery, and helpful in the developing early intervention in clinical practices. [ABSTRACT FROM AUTHOR]

Introduction: We examined COVID-19 trends and the socio-structural correlates of infections and vaccinations among people who inject drugs (PWID). Methods: We collected retrospective survey data from PWID (n = 472). We examined changes in COVID-19 testing, infection, and housing assistance for the first year of the pandemic, and then used multivariate logistic regression to examine factors with ever having an infection and receiving at least one vaccination from April 2020-March 2021. Results: The sample was mostly male, White and Latinx, and unhoused. Testing by quarter ranged from 46% to 33%. Housing assistance declined from 10% to 7% by the last quarter, while infections ranged from 6% to 4%. Ever being COVID-19 positive was associated with being male, having an income source, and being arrested in the last 3 months. Almost half of participants reported vaccination (47%). Receiving a vaccination was associated with prior U.S. armed forces service, older age, receiving substance use disorder treatment, and having ever received COVID-19 testing. Discussion: Efforts to vaccinate PWID fell short and housing assistance declined. Receiving targeted assistance, including better access to housing and medication treatments for opioid use disorder, could be important efforts to mitigate the heightened risks of COVID-19 and the ongoing harms PWID face that predate the pandemic. [ABSTRACT FROM AUTHOR]

Background: Substance use remains a public health threat with serious effects. It may be predicted by complex factors ranging from family to psychosocial disparities. We examined the magnitude of substance use and its influence on families among adolescents from Gitagata Rehabilitation Center. Methods: A cross-sectional study of 57 adolescents was conducted. Results: Our findings revealed that the proportion of substance users was higher (42 of 57 teens) than the proportion of non-substance users. Socio-demographic influences such as occupation, age and residence significantly increased the odds of substance use at p <.05. Adolescents who experienced domestic violence were more likely to be substance users [OR = 3.56; 95%CI (1.12–11.3)] than those who did not experience domestic violence. Children who were not neglected by their families were less likely to become substance users than neglected children [OR = 0.05; 95% CI (0.01–0.29)]. Adolescents from low-functioning families were more likely to be substance users [OR = 5.18; 95% CI (1.58–16.95)] than those from proper-functioning families. Those who were not properly monitored by their parents were more likely to use drugs [OR = 5.62; 95% CI (2.52–12.5)]. Conclusion: A multidisciplinary team is required to step up efforts to inform parents about their responsibility in lowering the likelihood that their children may use drugs by enhancing parental monitoring. [ABSTRACT FROM AUTHOR]

Background: Peer support workers (PSWs) are essential to the substance use treatment and recovery system, though they often lack access to professional development that accounts for the personal recovery experiences PSWs utilize in their work. Methods: This study is an evaluation of a series of five training modules for PSWs designed in collaboration with PSW consultants. Evaluation consisted of pre-/posttest knowledge questions and qualitative feedback from individuals who completed all five modules. Results: Knowledge scores increased for all five modules. Qualitative feedback was largely positive, with participants suggesting that integrating PSWs into the module development team made the finished product more relevant to PSWs. Conclusions: Findings affirmed the importance of providing training designed by and for PSWs working with people with substance use disorders and suggested that PSW confidence can be improved through targeted training. This training development model demonstrates promise for future substance use training programs for PSWs. [ABSTRACT FROM AUTHOR]

Aims: This study aims to investigate three-year follow-up among young adults who entered residential substance use disorder (SUD) treatment with regard to outcomes related to education, work and mortality. Methods: Participants who entered residential SUD treatment between 2011 and 2016 aged 16–29 years were included in the study. In this study, we used data from the electronic health records of the treatment facility of the participants and linked these with data from nationwide registries. The data included de-identified, person-level information on patient demographics, crime, treatment use and socioeconomic factors. The primary outcome was education and employment status, analyzed using logistic regression. Results: At the follow-up, two-fifths of the sample were in education or employment, half were receiving welfare benefits and the annual income level was low. 3.6% of the sample had died. Those who were in education or work were less likely to have post-treatment convictions and to use residential SUD treatment services than those who were not. Conclusion: Being in education or employment and not engaging in crime or severe substance use can create a life situation that helps to sustain recovery. There is a need to establish SUD treatment for young adults that includes education- and employment-focused interventions. [ABSTRACT FROM AUTHOR]

Background: The increasing misuse of methamphetamine in South-eastern Nigeria has raised serious public health concerns. The study aimed to explore perceived devaluation, alienation, discrimination, and consequences of methamphetamine (Mkpurummiri) misuse among young people in South-eastern Nigeria. Methods: Using a cross-sectional study design, we purposively recruited 18 users of methamphetamine in the setting. Perceived devaluation, alienation, and discrimination were measured with the Illicit Drug Use Stigma Scale, while Substance misuse behaviors were measured using the Drug Abuse Screening Test. Results: Only 22.2% of study participants had ever received treatment for methamphetamine misuse. Perceived devaluation was prevalent, with 100% of study participants reporting that most people think someone who uses drugs is unreliable. For alienation, 94.4% of study participants reported avoiding people because they might be looked down upon for using drugs. Over half (58.8%) experienced discrimination in accessing medical care. The majority (72.2%) have experienced blackouts or flashbacks due to methamphetamine misuse. Conclusion: The rates of devaluation, alienation, and discrimination by young persons who misuse Mkpurummiri in southeastern Nigeria are high and with social and health consequences. Multilevel interventions must be utilized to mitigate stigma and discrimination and to provide treatment and rehabilitation for affected individuals. [ABSTRACT FROM AUTHOR]

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]

Background: Drug use among men is a significant public health concern in China, with compulsory drug treatment centers being the primary approach. Police officers in these centers play a crucial role in shaping the interactions and experiences of men who use drugs (MWUD). However, little research exists on the attitudes of police officers toward MWUD in China.Objectives: This qualitative study aimed to explore the attitudes of police officers toward MWUD and drug rehabilitation approaches in China.Methods: Semi-structured individual interviews were conducted among 23 police officers recruited from two compulsory drug treatment centers in Jiangsu Province, China. Of the participants, two were females and 21 were males. Thematic analysis was employed to analyze the data.Results: Three key themes emerged: 1) Multifaceted perspectives on MWUD. Participants viewed MWUD as offenders, victims, and patients. 2) Dynamic interactions with MWUD. Relationships were characterized as either adversarial or supportive, influenced by participants’ personalities, experiences, beliefs, workload, and psychological training. 3) Advocating for punitive measures in drug rehabilitation. While the participants generally favored strict penalties for MWUD, they acknowledged the value of community-based rehabilitation. Concerns about social stigma, privacy, motivation, and the costs of voluntary rehabilitation tempered their support.Conclusions: The study highlights the importance of raising awareness and challenging bias among police officers. It emphasizes the need for psychological training to enhance their capacity to provide humane care and foster positive interactions with MWUD. Additionally, ensuring access to affordable, accessible, and stigma-free voluntary rehabilitation is crucial for effective drug rehabilitation efforts. [ABSTRACT FROM AUTHOR]

AbstractThis study sought to evaluate the outcomes of a community-based rehabilitation program for voluntary and court-mandated drug users in the Philippines. Participants went through a bio-psycho-social-spiritual group-based program that aimed to develop their recovery skills and life skills. The program also included family modules to enhance their knowledge of drug use, its effects, and the role of family in recovery. A cohort design was used with pre- and posttest surveys administered before and immediately after the program. The sample consisted of 105 voluntary clients and 118 court-mandated clients who underwent screening or drug dependency evaluation and were recommended for community-based treatment. The program was conducted weekly by trained paraprofessionals. Results reveal significant improvements in recovery and life skills, well-being, quality of life, and family support for both voluntary and court-mandated clients. No significant differences were found between groups, suggesting that community-based interventions are a viable alternative to inpatient or treatment in closed settings for both voluntary and court-mandated clients. [ABSTRACT FROM AUTHOR]

Background: Indigenous peoples with substance use disorders (SUD) and intergenerational trauma (IGT) face complex healthcare needs. Therefore understanding Indigenous patient experiences is crucial for enhancing care delivery, fostering engagement, and achieving optimal outcomes, yet few studies explore the motivations for seeking, staying in, and utilizing treatment from an Indigenous perspective. The goal of this study was to understand the patient experience with an abstinence-based treatment model in a residential treatment setting. Methods: A qualitative thematic study was conducted between April 2018 and February 2020 at Benbowpka treatment centre in Blind River, Ontario, Canada. We evaluated the results of the abstinence-based model intervention from the patient's perspective. The Client Quality Assurance Survey tool was employed to gather this data. The data underwent thematic analysis to derive meaningful insights. Results: A total of 157 patients were interviewed. The results were categorized into three parts: (1) Critical events that encouraged participants to seeking treatment; (2) Benefits experienced by participants while they were in the program; (3) Participants take-aways and priorities after completing the program. Core themes emerged in each category and each theme is sub-categorized into quadrants of the Medicine Wheel. Firstly, there was a critical juncture that significantly impacted participants' lives that motivated them to seek treatment at the Benbowpka Treatment Centre. Second, during the study, participants admission to the Benbowopka Treatment Centre, the participants benefitted from a holistic program that addresses spiritual, physical, mental and emotional aspects of healing. Third, participants identified tangible ways in which they implement the skills they gained during the program in their daily lives. Overall, study demonstrates that clients benefitted from both the program activities and the traditional healing practices. Conclusion: This research identified that SUD Indigenous residential treatment programs need to include culture, healing practices, activities and relationships that are part of the treatment process. This study found that the cultural elements and healing practices of the program were highly valued by clients. [ABSTRACT FROM AUTHOR]

Objective: To study the heterogeneity and influencing factors of self-acceptance of drug addicts in compulsory isolation in 2 drug rehabilitation centers in Sichuan Province, and to analyze the effects of different types of self-acceptance on subthreshold depression in drug addicts, in order to provide useful references for improving their mental health. Methods: Self-acceptance Questionnaire (SAQ), Drug use Stereotype Threat Scale(DSTS) and Center for Epidemiologic Studies Depression Scale(CES-D) were used to conduct a questionnaire survey in January 2024 on 1068 drug addicts in two compulsory isolation drug rehabilitation centers in Sichuan Province. Results: Drug addicts self-acceptance can be categorized into 5 potential categories; men were more likely than women to show lower self-acceptance in the 'low-low'(β = 0.285,OR = 0.381, p < 0.001),'low-high'(β = 0.331,OR = 0.383,p = 0.004), and'high-low'(β = 0.283,OR = 0.548, p = 0.033) groups compared to the ' high-high' group; drug addicts with an education level of elementary school and below were categorized into the'low -low ' group(β = 0.642,OR = 6.173, p = 0.005);HIV-negative drug addicts were more likely to show higher self-acceptance than positive patients(β = 0.418,OR = 2.427, p = 0.034)); the'low-low'group had the greatest likelihood of being alienated(β = 0.169,OR = 3.249, p < 0.001). The results of multiple linear regression showed that drug addicts in the' moderate-moderate 'group and'high-high 'group had significantly lower subthreshold depression than those in the'low-low 'group; the results of the Kruskal-Wallis Test showed that the'high -high 'group had the lowest level of subthreshold depression, and the'low -low ','low-high 'and'high-low 'groups had the highest mean ranks in different dimensions of subthreshold depression(P < 0.001). Conclusion: Heterogeneity exists in drug addicts' self-acceptance, and gender, HIV-positive or not, education level, and drug use stereotype threat are factors influencing self-acceptance in compulsory isolated drug addicts. High self-appraisal-high self-acceptance had the lowest level of subthreshold depression in drug addicts, and the consistency of poor self-appraisal and self-acceptance also affected the level of subthreshold depression in drug addicts. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the extent of student awareness about collegiate recovery communities (CRCs) and of peers in recovery. Participants: A convenience sample of 237 undergraduate students from a diverse major at a private university participated in an anonymous online survey in Fall 2019. Methods: Participants reported whether they knew about the local CRC, whether they knew a peer in recovery, sociodemographic characteristics, and other information. Multivariable modified Poisson regression models were fitted to estimate correlates of awareness of the CRC and of peers in recovery. Results: Overall, 34% were aware of the CRC and 39% knew a peer in recovery. The latter was associated with being a member of Greek life, a junior or senior, using substances regularly, and personally being in recovery. Conclusions: Future research should explore ways to increase awareness of CRCs and assess the role of connections between students in recovery and peers across campus. [ABSTRACT FROM AUTHOR]

Integrated behavioral healthcare interventions have increased access to care for people with behavioral health conditions in primary care settings. However, they have not been widely implemented in low-barrier HIV care settings where undertreated behavioral health needs remain high. We conducted a formative qualitative evaluation, using in-depth interviews with purposively selected stakeholders (n = 13) and patients (n = 16), to identify anticipated barriers and facilitators to integrating care for depression and opioid use disorder for people with HIV via the Collaborative Care Model at a low-barrier HIV clinic. Patients and stakeholders expressed their enthusiasm for the Collaborative Care Model based on its perceived relative advantage over the standard of care referral system. Availability of resources, practical concerns about perceived fit with low-barrier HIV care, and anticipated suitability given other behavioral health comorbidities and patients' complex socioeconomic needs partially tempered stakeholder perceptions of appropriateness for the Collaborative Care Model. Patients and service delivery stakeholders were receptive to the Collaborative Care Model, but felt it was moderately appropriate in the context of low-barrier HIV care, which necessitated key adaptations to core model components to improve its contextual fit. [ABSTRACT FROM AUTHOR]

Substance use among youth aged 12 to 17 presents a major public health concern in the United States with statistics revealing that one in eight youths have engaged in illicit substance misuse within the past year (National Center for Drug Abuse Statistics, 2023). The long‐term consequences of youth substance use include complicated medical issues, mental health disorders, impaired brain development, social and behavioral issues, addiction and dependence problems, and financial and legal consequences. By comprehending, preventing, and addressing factors of youth substance use, parents, educators, and healthcare providers can protect the well‐being of young individuals, their families, and the community. [ABSTRACT FROM AUTHOR]

Although the concept of gender role conflict has advanced contemporary research on the psychology of men and masculinities, there has been little exploration of gender role conflict within clinical samples of men. Consequently, variable- and person-oriented approaches to the analysis of data collected from a racially and ethnically diverse sample of 224 fathers living in southern New England were used to document differences in gender role conflict when fathers with an opioid use disorder were compared with fathers living in the same community without an alcohol or drug use disorder. Analyses of covariance indicated that, after allowance for demographic characteristics, the clinical group reported significantly more concern about restrictive emotionality and restrictive affectionate behavior between men. Cluster analysis indicated that there were five potentially meaningful profiles of gender role conflict among the fathers. Multinomial logistic analysis examining assignment to clusters representing more versus less concern showed that, after allowance for demographic characteristics, the odds were much greater that the fathers in the clinical group were assigned to clusters reflecting more concern about gender role conflict. The results highlight ways internalization of masculinities emphasizing constriction of emotional expression and interpersonal relations may represent risk for opioid addiction, and they illustrate how documentation of differences in masculine constructs may inform gender-sensitive parent intervention pursued with fathers in clinical and community contexts. Public Significance Statement: Opioid addiction is a serious public health problem that affects men more than women during early to middle adulthood when most men first become a father. When compared with other fathers in two different statistical analyses, fathers receiving treatment for an opioid addiction demonstrated important differences in gender role conflict. The results highlight ways concepts like gender role conflict drawn from the contemporary study of masculinities may inform the psychological assessment and treatment of fathers struggling with an opioid addiction and other behavioral health problems. [ABSTRACT FROM AUTHOR]

The article focuses on the clinical practice guidelines for assessing the needs of long-stay psychiatric patients with mental illness and substance use disorders (SUD). Topics include the process of developing needs assessments; factors influencing discharge planning and readiness; and the importance of recovery-oriented, person-centered care that addresses both mental health and physical health needs.

Background and aims: Ecological momentary assessment (EMA) studies have previously demonstrated a prospective influence of craving on substance use in the following hours. Conceptualizing substance use as a dynamic system of causal elements could provide valuable insights into the interaction of craving with other symptoms in the process of relapse. The aim of this study was to improve the understanding of these daily life dynamic inter‐relationships by applying dynamic networks analyses to EMA data sets. Design, setting and participants: Secondary analyses were conducted on time‐series data from two 2‐week EMA studies. Data were collected in French outpatient addiction treatment centres. A total of 211 outpatients beginning treatment for alcohol, tobacco, cannabis, stimulants and opiate addiction took part. Measurements: Using mobile technologies, participants were questioned four times per day relative to substance use, craving, exposure to cues, mood, self‐efficacy and pharmacological addiction treatment use. Multi‐level vector auto‐regression models were used to explore contemporaneous, temporal and between‐subjects networks. Findings: Among the 8260 daily evaluations, the temporal network model, which depicts the lagged associations of symptoms within participants, demonstrated a unidirectional association between craving intensity at one time (T0) and primary substance use at the next assessment (T1, r = 0.1), after controlling for the effect of all other variables. A greater self‐efficacy at T0 was associated with fewer cues (r = −0.04), less craving (r = −0.1) and less substance use at T1 (r = −0.07), and craving presented a negative feedback loop with self‐efficacy (r = −0.09). Conclusions: Dynamic network analyses showed that, among outpatients beginning treatment for addiction, high craving, together with low self‐efficacy, appear to predict substance use more strongly than low mood or high exposure to cues. [ABSTRACT FROM AUTHOR]

Background: Women with substance use disorder (SUD) experience higher rates of violence exposure, post-traumatic stress disorder (PTSD), and post-traumatic stress symptoms (PTSS) than their non-substance-using peers. Exposure to violence in women with SUD is associated with PTSS symptom severity and leads to lower rates of treatment adherence, poorer treatment outcomes, and a higher risk for relapse. Little is known about the buffers to PTSS among violence-exposed women with SUD. Methods: A sample of 375 women with SUD were recruited from three inner-city intensive treatment centers, in a midwestern city. Using ordinary least squares regression models, we sought to identify the direct effects of violence, general social support, recovery-specific social support, and social network composition on PTSS. Moderation was also examined using the Bootstrapping function in PROCESS macro for SPSS. Results: General social support, recovery social support, and greater duration of network relationships were associated with lower trauma symptom scores. General social network composition variables were directly associated with lower trauma symptom severity. Recovery-specific social network variables moderated the association between violence exposure and PTSS for Black participants only. Conclusions: These data suggest that providers should target the quality of the client's interpersonal relationships to reduce PTSS among violence-exposed women with SUD. Maintaining social network relationships should be the focus of treatment interventions for women with SUD who have experienced violence. [ABSTRACT FROM AUTHOR]

Lifestyle medicine (LM) utilizes evidence-based therapeutic lifestyle changes to address lifestyle factors that impact health, performance, and injury risk and recovery. By integrating LM principles into clinical care, workplace policies, and programs, along with other evidence-based methods, occupational and environmental medicine clinicians and medical directors can enhance worker health and performance, manage chronic disease, and facilitate faster recovery from injury and illness. This guidance addresses approaches that can be used in the clinic and workplace to address tobacco, substance misuse, nutrition, physical activity, overweight/obesity, sleep, mental well-being, and social connectedness. [ABSTRACT FROM AUTHOR]

People seeking substance use disorder (SUD) treatment could benefit from nutrition services, including nutrition education, addressing common concerns like malnutrition. This cross-sectional study assessed the inclusion of nutrition education and registered dietitian nutritionists (RDNs) at SUD treatment facilities in New Mexico (NM). Of 80 eligible facilities identified via SAMHSA's online database in 2020, 18 (23%) completed a survey. Eight (44%) offered nutrition education that reinforced basic or essential nutrition-related knowledge; just one (6%) had an RDN. Most NM SUD treatment facilities do not offer nutrition education, but nutrition education/counseling provided by an RDN should be considered in comprehensive SUD treatment. [ABSTRACT FROM AUTHOR]

To describe and evaluate a cost-effective, integrated model of service provision for people with Alcohol Related Brain Damage (ARBD). Participants identified by three large acute hospitals as having ARBD and suitable for recovery and rehabilitation were offered a 12-week recovery-focussed program at a residential unit. The unit is a collaboration between an NHS board, the local council, and a 3rd sector organization Participants' pre-admission and post-admission medical data was gathered to analyze the effectiveness of the unit's program on Emergency Department (ED) attendance and inpatient bed use. Improvement in cognition was measured by comparing the ACE-III results for all participants at admission and just prior to discharge from the program. Thirty-one participants met the inclusion criteria. Paired t-tests revealed the 12-week program overall significantly reduced attendance at ED, use of in-patient beds after discharge, and improved cognitive functioning. This integrated model of service provision provides clear benefits to residents' cognitive functioning and to the NHS by freeing up inpatient beds and ED capacity. Therefore, it should be considered by commissioners when addressing the needs of people with ARBD. [ABSTRACT FROM AUTHOR]

Expanding workforce training opportunities for opioid use disorder (OUD) treatment is a priority. We report on the impact of a 6-month-long team training program using the Extension for Community Healthcare Outcomes (ECHO) model to scale an interprofessional education (IPE) intervention to primary care teams who offered medications for OUD treatment as part of their care plan. Thirteen healthcare teams participated in the program's first cohort. We studied 52 participants' pre-post responses to seven scales that examined individual efficacy, team efficacy, high performance teamwork behaviors, adaptive teamwork behaviors, ability to treat patients in two case examples, and stigma and harm reduction. Significant improvements occurred on six scales. Large effect sizes were observed for individual efficacy (d = 0.78), team efficacy (d = 1.25), and team's ability to treat patients (d = 0.77, d = 0.83). Moderate effect sizes were observed for high performance teamwork behaviors (d = 0.69) and adaptive teamwork behaviors (d = 0.57). Only stigma and harm reduction did not show a change. The training program delivered an IPE-ECHO intervention that was effective at increasing the teams' perceptions of their efficacy, functioning, and ability to treat patients. Future researchers should use objective measures to verify the team's perceptions of their increased ability to work together. [ABSTRACT FROM AUTHOR]

Objective: Early leaving in substance use disorder treatment may be the single largest variable undermining treatment success. Existing work on early leaving tends to explore either client factors, which include age, race, gender, and diagnoses, or treatment factors, which include the type of treatment activities offered, treatment experiences of clients and staff, treatment amenities, and environmental factors in the residential treatment program. However, existing work on both client factors and treatment factors provides mixed results on what contributes to early leaving. Further, there has been very little research in the private residential treatment setting. This study aims to explore the factors influencing early leaving in a private residential treatment setting. Methods: The study analyzed admission and treatment records from 247 consecutive clients at a private treatment facility in Southern California to identify factors related to shorter retention. The program employs a biopsychosocial approach and evidence-based practices to assist clients in recovery from substance use disorders and mental health conditions. We utilize a battery of client measures, including the Outcome Questionnaire 45.2, Trauma History Questionnaire, as well as demographic and psychiatric variables in our analyses. Results: Findings challenge previous research by showing that age and gender do not predict shorter retention, contrary to findings in the extant literature on public treatment centers. Instead, clients with higher symptoms of distress stay longer, as indicated by scores on the Outcome Questionnaire 45.2. Additionally, we find the majority of the cohort stayed in residential treatment for more than 30 days, with the average length of stay being 47.92 days, indicating that treatment completion of clients with severe symptomatology for an extended time in treatment (30 days or more) is achievable. Conclusions: The study underscores the importance of considering client symptomologies and severities in understanding and improving retention in substance use disorder treatment programs. This study highlights the potential impact of treatment services offered in private settings on client retention. [ABSTRACT FROM AUTHOR]

Objective: Motivational interviewing (MI) is a client centered counseling approach which aims to promote behavior change by enhancing patient motivation through the exploration and resolution of ambivalence. This type of psychotherapy, initially designed for the treatment of substance use disorders (SUD), is now seen as an effective way to manage chronic physical and psychiatric diseases. Patients with Dual Diagnosis (DD), people who simultaneously have a SUD diagnosis and a mental illness, are a complex group of psychiatric patients who have a particularly low treatment engagement. It was hypothesized that MI could be a valuable add-on therapy for DD patients. This review summarizes the main findings of randomized controlled trials applying MI to patients' psychiatric diagnoses and substance use. We aim to clarify previous inconsistent results regarding MI effectivity in this complex and challenging disorder. Method: The systematic literature search of PubMed/MEDLINE, Web Of Science and Scopus followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The final selection for this systematic review comprised exclusively of randomized controlled trials (RCTs) comparing MI alone or integrated into routine care. All patients included in the selected studies were over 16 years old. The studies' quality assessment was conducted with the Jadad Scale. Results: 8 RCTs were included in this review. The patients who underwent MI interventions showed an improvement in functioning, psychiatric symptoms, medication compliance and substance use, although without statistical significance. The number of relapses, total days in relapse and alcohol binge days showed a significant improvement in favor of the intervention group (p =.002, Bellack et al., 2006; p =.006, Haddock et al., 2003; and p =.02). Conclusions: Although there was a clear improvement in most of these outcomes, most studies failed to detect significant results. A significant clinical outcome of MI application was found in lower relapse occurrence and alcohol abuse. The disparity of findings may be due to the disorder's heterogeneity, and/or to methodological limitations. Our results emphasize the need for more methodically sound RCTs with adaptable characteristics specific to the pairing of psychiatric disease and substance abuse. [ABSTRACT FROM AUTHOR]

Objective: Adverse Childhood Events (ACEs) are associated with increased vulnerability for posttraumatic stress disorder (PTSD), but not everyone who experiences ACEs develops PTSD. Impulsivity has gained interest as a potential mediator between ACEs and PTSD, given that both PTSD and ACEs have been closely related to impulsivity. However, less is known about the relationship within the context of substance use disorder (SUD), a population highly vulnerable to co-occurring PTSD. This study examined whether impulsivity mediates the relationship between ACEs and PTSD symptoms in adults seeking residential treatment for substance use disorder (SUD). Methods:N = 134 consenting adults in residential treatment for SUD completed questionnaires measuring impulsivity (UPPS-P), ACEs (ACEs Scale), and PTSD symptoms (PCL-5). Regression models tested our hypotheses that ACEs would predict PTSD symptoms and that impulsivity would mediate this relationship. Results: Two-thirds of participants met the PCL-5 score threshold for a provisional diagnosis of PTSD. ACEs score and impulsivity were significant direct predictors of PTSD symptoms (coeff = 2.23, p <.001; coeff = 1.03, p <.001). Among UPPS-P subconstructs, only lack of premeditation emerged as a partial mediator (z = 2.14, p = 0.032). Conclusions: Individuals with SUD experience adverse and traumatic events at alarming rates and are at increased risk for PTSD. Our mediation finding suggests that impulsivity and especially lack of premeditation may be clinically relevant in the development or maintenance of PTSD symptoms among individuals with SUD. [ABSTRACT FROM AUTHOR]

There has been minimal research linking the effects on racial-ethnic minorities' health outcomes, particularly research focused on racial-ethnic minorities seeking outpatient substance abuse treatment in the United States. The Great Recession from December 2007 to June 2009 in the United States provides the backdrop against the completion of substance abuse treatments among racial-ethnic minorities that may be associated with the impacts on users' social realities. We utilized data from the 2006–2011 Treatment Episode Datasets–Discharge (TEDS-D) dataset which collects data on outpatient substance abuse treatment institutions throughout the United States. The substance abuse treatment completion rates were higher prior to the Great Recession and lower following the Great Recession. Hispanics were more likely than non-Hispanic whites to complete substance abuse treatment, while other minority groups such as Non-Hispanic Blacks, were less likely to do so. Clients in the Northeast and West regions were more likely to successfully complete substance abuse treatment than those in the South. These findings have implications for impacting outpatient substance abuse treatment completion rates following the Great Recession to reduce racial-ethnic disparities which were impacted by region. Even amid an economic recession, treatment for substance abuse should continue to be a top concern. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The benefits of early rehabilitation for patients with acute heart failure (HF) requiring IV inotropic drugs have yet to be determined. We investigated the association between early rehabilitation and short-term clinical outcomes in patients with acute HF requiring IV inotropic drugs. DESIGN: Retrospective cohort study. SETTING: This study used data including more than 90% of patients at a tertiary emergency hospital in Japan. PATIENTS: This study included patients with acute HF who required IV inotropic drugs within 2 days of admission. INTERVENTIONS: We compared patients who commenced rehabilitation within 2 days of admission (the early rehabilitation group) and those who did not (the control group). MEASUREMENTS AND MAIN RESULTS: Propensity score matching was used to compare in-hospital mortality, 30-day all-cause and HF readmissions, length of stay, and Barthel Index (BI) at discharge between patients who received early rehabilitation and those who did not. Totally, 38,302 patients were eligible for inclusion; of these, 5,127 received early rehabilitation and 5,126 pairs were generated by propensity score matching. After propensity score matching, the patients who received early rehabilitation had a lower in-hospital mortality rate than those who did not (9.9% vs. 13.2%; p < 0.001). The relative risk (95% CI) of early rehabilitation for in-hospital mortality was 0.75 (0.67–0.83). Patients undergoing early rehabilitation exhibited a shorter mean length of stay (25.5 vs. 27.1; p < 0.001), lower 30-day all-cause (14.1% vs. 16.4%; p = 0.001) and HF (8.6% vs. 10.4%; p = 0.002) readmissions, and higher BI scores at discharge (68 vs. 67; p = 0.096). Consistent findings were observed across subgroups, including in patients 80 years old or older, those with a body mass index less than 18.5 kg/m2, and those with BI scores less than 60. CONCLUSIONS: The early prescription of rehabilitation was associated with favorable short-term outcomes even for patients with acute HF requiring IV inotropic drugs. [ABSTRACT FROM AUTHOR]

Scant research has been published on online addiction treatment, with few studies focusing on the Theory of Planned Behavior (TPB) in relation to addiction treatment. Therefore, this study aims to explain the TPB's predictability on intention and behaviors in relation to online addiction treatment among people recovering from substance use disorder (SUD). Methods: This descriptive-analytical study included a self-report questionnaire based on the TPB model, and was distributed to a sample of 115 people recovering from SUD, aged 18-69, 62% of whom were men. Results: Attitude, Subjective Norms (SN), and Perceived Behavioral Control (PBC) toward online addiction treatment was significantly positive in relation to intention and past behavior of participants in online addiction treatment. Attitude and PBC were found to be significant predictors, and the TPB model was found to be significant {F (3,111) = 47.29, p < 0.01}, explaining 56% of the variance of intention for participants in online addiction treatment. Conclusion: As online treatment is a relatively new tool in addiction treatment, professionals and treatment providers should encourage beliefs, attitudes, moral norms, and perceived behavior control to increase intentions among future participants in online addiction treatment. [ABSTRACT FROM AUTHOR]

Background: Opioid misuse is a significant public health crisis. The aim sought to identify potential gaps in opioid care in primary care practices. Methods: American Academy of Family Physicians (AAFP) offered a monthly online educational series to seven U.S. practices. Practices were asked to complete up to 50 chart reviews for visits during two periods: February–April, 2019, and February–April, 2022. Each chart had to have an ICD-10 diagnosis of opioid misuse, opioid dependence, or opioid use. Chart reviews consisted of 14 questions derived from an American Academy of Addiction Psychiatry (AAAP) Performance in Practice activity, and then, scored based on practices' responses. Descriptive statistics and binary logistic and multinomial regressions were used. Results: Both periods had 173 chart reviews (total: 346) from the six practices. Most chart reviews were for patients with a diagnosis of opioid dependence (2019: 90.2%; 2022: 83.2%). Three questions for assessing OUD treatment behaviors had high levels of documentation across both time periods (>85%): other drug use, treatment readiness, and treatment discussion. Discussion: Results show a gap in the treatment of patients with OUD in primary care across several clinical practice recommendations. Conclusions: Expanding OUD treatment integration to primary care remains the most promising effort to combat the opioid crisis. [ABSTRACT FROM AUTHOR]

Objective: Routine health data has the potential to identify changes in patient-related outcomes, in close to real time. This pilot project used routine data to explore and compare the impact of changes to cultural responsiveness on service use by Aboriginal and Torres Strait Islander (hereafter, Aboriginal) clients in Australia. Methods: The New South Wales Minimum Data Set (MDS) for alcohol and other drug use treatment services was provided for 11 services for a period of 30 months from March 2019 to September 2021 (four months prior to two years after the intervention; data were analysed between March 2022 to February 2023). Change in cultural responsiveness was assessed via practice audits of services at baseline and two years. The average change in audit rating was analysed using a linear mixed regression model. Generalised Linear Mixed Models were used to identify changes in service use by Aboriginal clients. Results: All 11 services showed increased audit scores at two years, with a statistically significant mean increase of 18.6 (out of 63 points; b = 18.32, 95% CI 12.42-24.22). No statistically significant pre-to post-changes were identified in: (1) the proportion of episodes delivered to Aboriginal versus non-Aboriginal clients (OR = 1.15, 95% CI = 0.94-1.40), (2) the number of episodes of care provided to Aboriginal clients per month (IRR = 1.01, 95% CI = 0.84-1.23), or (3) the proportion of episodes completed by Aboriginal clients (OR = 0.96, 95% CI = 0.82-1.13). Conclusions: The lack of statistically significant impact on service use outcomes using MDS contrasts to the improvements in cultural responsiveness, suggesting further work is needed to identify appropriate outcome measures. This may include patient-reported experience measures. This project showed that routine data has potential as an efficient method for measuring changes in patient-related outcomes in response to health services improvements. [ABSTRACT FROM AUTHOR]